====== Glioma surgery complications ====== These [[complication]]s can be broadly divided into neurologic, regional, and systemic, including direct cortical and vascular injury, surgical wound complications, and postsurgical medical complications. Certain patient characteristics, including Karnofsky performance status score (KPS) and pathology of the tumor, have been shown to have an impact on the risk of postsurgical complications. Advancement in preoperative and intraoperative adjunct technology such as cortical mapping and navigation has improved the surgeon's ability to safely and maximally resect the tumors. It is therefore important to understand the perioperative complications after craniotomy and tumor resection and factors affecting morbidity and mortality in order for surgeons to optimally select and counsel patients who will benefit the most from surgical resection ((Jackson C, Westphal M, Quiñones-Hinojosa A. Complications of glioma surgery. Handb Clin Neurol. 2016;134:201-18. doi: 10.1016/B978-0-12-802997-8.00012-8. PMID: 26948356.)). ---- Ischemia after [[high-grade glioma surgery]] are frequent and may constitute potential cause of false-positive results in postsurgical evaluation using [[18F fluorocholine positron emission tomography]]. On the other hand, [[hypoxia]] caused by [[ischemia]] promotes invasive glioma growth. García Vicente et al., presented 3 cases of patients with different grades of ischemic injury after resection of [[High-grade glioma]]. The combined interpretation of [[diffusion weighted imaging]] and [[apparent diffusion coefficient]] map on MRI, in this clinical setting, is mandatory to avoid PET/CT misinterpretations ((García Vicente AM, Rodriguez Muñoz MJ, Pena Pardo FJ, Martinez Madrigal MM, Soriano Castrejón A. Ischemic Complications After High-Grade Glioma Resection Could Interfere With Residual Tumor Detection With 18F-Fluorocholine PET/CT. Clin Nucl Med. 2018 Dec 3. doi: 10.1097/RLU.0000000000002392. [Epub ahead of print] PubMed PMID: 30516681. )). ===== Global aphasia after glioma surgery ===== [[Global aphasia after glioma surgery]] ===== Ventricular Entry ===== The consequences of ventricular entry during resection of [[High-grade glioma]]s (HGG) are uncertain and often not detectable clinically. Mistry et al. searched titles and abstracts of published journals in the NCBI/NLM [[PubMed]] and [[OVID]] [[EMBASE]] databases were searched without language restriction and systematically screened. Outcomes extracted included the [[odds]] of [[leptomeningeal dissemination]] and hydrocephalus in patients with ventricular entry during HGG resection compared to without. They were analyzed using a random-effects model to calculate summary [[odds ratio]]s (sORs). [[Overall survival]] data were also compared between patients with and without ventricular entry. Twenty final studies with 2251 total patients were included from the 6910 retrieved. Patients with ventricular entry during HGG resection demonstrated higher odds of leptomeningeal dissemination (sOR: 3.91 [95% confidence interval (CI): 1.89-8.10]; P = .0002; 86/410 vs 57/847 patients in 9 studies) and hydrocephalus (sOR: 7.78 [95% CI: 3.77-16.05]; P < .00001; 58/431 vs 11/565 patients in 11 studies). They also had decreased survival (median survival: 16.8 vs 19.1 mo; 413 vs 322 patients in 10 studies; hazard ratio: 1.25 [95% CI: 1.05-1.48], P = .01). The association between ventricular entry during HGG resection and tumor [[dissemination]], hydrocephalus, and decreased survival invites investigations to understand this link. Neurosurgeons and neuro-oncologists must be aware of the consequences of ventricular entry during surgery for HGG ((Mistry AM, Kelly PD, Thompson RC, Chambless LB. Cancer Dissemination, Hydrocephalus, and Survival After Cerebral Ventricular Entry During High-Grade Glioma Surgery: A Meta-Analysis. Neurosurgery. 2018 Dec 1;83(6):1119-1127. doi: 10.1093/neuros/nyy202. PubMed PMID: 29790976. )).