Detecting any residual tumour tissue after surgical resection is crucial for postoperative management, radiotherapy and/or chemotherapy and accurate assessment of the patient's prognosis. CT and/or MR scans are among the tools available for postoperative follow-up. We report the results of a series of 132 primary intracerebral tumours resected between 1st January 1996 and 31st December 1996. Most of the tumours were highly malignant gliomas followed by low grade gliomas, gangliocytomas, ependymomas and medulloblastomas. Early postoperative neurological investigation before and after contrast administration was performed in all cases. In line with literature reports, postoperative follow-up was done on the third or fourth day after surgery so that surgically induced tissue changes would not prevent detection of possible tumour residue. CT was chosen for malignant tumours and MR for low grade gliomas or tumours of the posterior fossa. In the 98 cases in which surgical resection had been partial or subtotal, neuroradiological investigation disclosed tumour residue. Of the 34 cases in which a total tumour resection was performed, the presence of residual tumour tissue was certain in 14, doubtful in four and absent in nine. The presence of haematoma in seven patients precluded a definitive assessment. Establishing the presence of tumour residue after surgery is necessary to determine the patient's prognosis and plan postoperative management. The prognosis worsens dramatically in the presence of residual tumour tissue: 75% of patients with malignant glioma suffer a recurrence within six months when tumour residue is detected on postoperative follow-up, as opposed to only 36% of patients without residue. In planning postoperative management, radiotherapy or chemotherapy, it is essential to establish the presence of possible tumour residue. Malignant tumours with residual tumour tissue can be treated by conventional radiotherapy followed by a target boost with radiosurgery or brachytherapy. Nowadays, chemotherapy is reserved for patients with postoperative tumour residue. Radical tumour resection is still the primary treatment for low grade malignant tumours. If complete operative removal is accomplished in patients under thirty years of age, radiotherapy can be postponed until the time of possible tumour recurrence. For diagnostic purposes, it is extremely important to perform neuroradiological follow-up immediately after surgery to facilitate the detection of possible tumour recurrence or lesions caused by irradiation.
|Number of pages||6|
|Journal||Rivista di Neuroradiologia|
|Publication status||Published - 1999|
ASJC Scopus subject areas
- Clinical Neurology
- Radiology Nuclear Medicine and imaging
- Radiological and Ultrasound Technology