urgent surgical treatment of cerebral neoplasm complications

URGENT SURGICAL TREATMENT URGENT SURGICAL TREATMENT OF OF

CEREBRAL NEOPLASM CEREBRAL NEOPLASM COMPLICATIONSCOMPLICATIONS

Authors: SpasiAuthors: Spasić Svetolik ć Svetolik 11, , Đurović BĐurović Brankoranko 11 1 Clinic for neurosurgery, Clinical Centre of Serbia, Dr Koste Todorovića 4, 11000 Belgrade, Serbia

Time

Neurological deficit

Figure 1. Effects of time past prior to surgery on GCS (Glasgow Coma Score) and neurological deficit

• The aim of this study was to define main indicationsdefine main indications for an emergency surgical treatment and to assess the effects assess the effects of neurosurgical procedures

Materials and methodsMaterials and methods• Retrospective analysis of 20 patients (age 16-60) treated in the

neurosurgical unit, Emergency Center Belgrade

• Obtained data was based on patient history, neurological examination and imaging studies (CT scans – visualization of intracranial compressive effect of the tumor and/or associated complications)

• Parameters observed – neurological deficit and Glasgow Coma Score (GCS) before and after surgical procedure

• Initial hypothesisInitial hypothesis: • main indication for a surgical procedure is a severe deterioration of consciousness

(GCS ≤ 7)• Neurosurgical procedure – only effective course of treatment

Conditions associated with brain tumors

Hemorrhage Hydrocephalus Edema Mass effect

35% 30% 25% 10%

Table 1. Frequency of cerebral neoplasm complications in patient population

ResultsResults II II

Chart 1. Effects of surgical treatment on median value of GCS in patient population

• Neurosurgical procedures have shown significant positive effect on values of GCS in patients, since median value of GCS (med GCS) before surgery was 9 and 13 after surgery (Z=2,4; p=0,017)

ResultsResults III III

Chart 2. Prevalence of patients with different degrees of consciousness disorder

• Patient population was divided into three groups, based on a degree of consciousness disorder: sever (group I) , moderate (group II) and mild (group III). Majority of patients treated were in the I group (45%), which was the group of particular interest

Results IVResults IV

Chart 3. Effects of surgical treatment on median value of GCS in groups of patients ( light shade – preoperative med GCS, dark shade – postoperative med GCS )

• Neurosurgical procedure had most positive impact on patients with severe consciousness disorder (group I) (Z=2,5; p=0.011)

Results VResults V

Chart 4. Effects of neurosurgical procedure on neurological symptoms in patient population (blue– incidence of neurological deficit before surgery, red – incidence of neurological deficit after surgery)

*

* p<0,001

• Surgery had positive effect on patients who presented with consciousness disorder and dysphasia (Chi-square=12, p<0,001)

Results VIResults VI• High degree of positive correlation was shown between preoperative and postoperative GCS in

patient population (r=0,651; p=0,007). High degree of positive correlation was established, between preoperative GCS, and postoperative GCS in patients with severe consciousness disorder (group I)

Graph 1. Correlation of preoperative and postoperative GCS values in patient population

ConclusionConclusion