Authors: Spasi ć S vetolik 1 , Đurović B 1

1. Figure 1. Effects of time past prior to surgery on GCS (Glasgow Coma Score) and neurological deficit GCS Neurological deficit 1st Congress of Southeast European Neurosurgical Society – SEENS Belgrade, 31st October – 2nd November 2013 URGENT SURGICAL TREATMENT OF CEREBRAL NEOPLASM COMPLICATIONS Time 1 Clinic for neurosurgery, Clinical Centre of Serbia, Dr Koste Todorovića 4, 11000 Belgrade, Serbia AIM INTRODUCTION • A well known fact is that, regardless of biological behavior of brain tumors, their intracranial location is what most authors describe as malignant • Although expansion of a tumorous mass can cause increased ICP by itself, brain tumors are frequently associated with several conditions - cerebral edema, intracranial hemorrhage and hydrocephalus • Expansive process increases ICP and develops a pressure gradient between supratentorial and infratentorial spaces as well as intracranial and intraspinal spaces, leading to a risk of brain herniation • Abrupt neurological deterioration – neurosurgical emergency • Neurosurgical management crucial for adequate brain decompression , since sole medicamentous treatment hasn’t proven to be effective • The aim of this study was to define main indicationsfor an emergency surgical treatment and to assess the effects of neurosurgical procedures MATERIALS AND METHODS • Retrospective analysis of 20 patients (age 16-60) treated in the neurosurgical department of the Emergency Center - Belgrade • Obtained data was based on patient history, neurological examination and imaging studies • CT scans – visualization of intracranial compressive effect (“midline shift”) of the tumor and/or associated complications. • Parameters observed – neurological deficit and Glasgow Coma Score (GCS) before and after surgical procedure • Neurosurgical decompression procedures included: a gross resection of the tumor, if possible, evacuation of hematomas via the most direct pathway and hydrocephalus was managed with temporary derivation of CSF and permanent derivation of CSF by implanting VP shunts. • Initial hypothesis: • - Main indication for a surgical procedure is a severe deterioration of consciousness (GCS ≤ 7) • - Neurosurgical procedure – only effective course of treatment RESULTS • Neurosurgical procedures have shown significant positive effect on values of GCS in patients since median value of GCS before was 9 and 13 after surgery (Z=2,4; p=0,017) (Chart 1.) • Surgery had positive effect on patients who presented with consciousness disorder and dysphasia (Chi square=12, p<0,001) (Chart 2.) • In order to prove the existence of correlation between presumed indication and treatment outcome, 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 • Neurosurgical procedure had most positive impact on patients with severe consciousness disorder (group I) (Z=2,5; p=0.011) (Chart4.) • Furthermore a high degree of positive correlation was shown between preoperative and postoperative GCS in patient population (r=0,651; p=0,007) (Graph 1.) • Additionally a high degree of positive correlation was established, between preoperative GCS, which was the main indication presented in the initial hypothesis and postoperative GCS which depicts treatment outcome in patients with severe consciousness disorder (group I) (r=0,771; p=0,015) Authors: Spasić Svetolik 1, Đurović B1 Table 1. Frequency of cerebral neoplasm complications in patient population Chart 2. Effects of surgical treatment on neurological deficit in patient population (blue– incidence of neurological deficit prior to surgery, red – incidence of neurological deficit after surgery) Chart 1. Effects of surgical treatment on median value (med) GCS in patient population Graph 1. Correlation of preoperative and postoperative GCS values in patient population Chart 4. Effects of surgical treatment on median value of GCS in groups of patients (light shade – preoperative med GCS , dark shade – postoperative med GCS Chart 3. Prevalence of patients with different degrees of consciousness disorder CONCLUSION • Two main indications were defined: • Severe deterioration of consciousness • Substantial compressive effect (“midline shift”) of the tumor and/or associated expansive process, visualized on CT scans • Defining indications promptly is one of the most important steps in neurosurgical treatment • Neurosurgical procedure is the only effective course of treatment of brain tumors and/or associated complication leading to herniation and incarceration of cerebral entities