Discriminating surgical bed cysts from bacterial brain abscesses after Carmustine wafer implantation in newly diagnosed IDH-wildtype glioblastomas.

Adult Antineoplastic Agents, Alkylating / therapeutic use Brain Abscess / chemically induced Brain Neoplasms / drug therapy Carmustine / adverse effects Cysts / chemically induced Glioblastoma / drug therapy Humans Middle Aged Retrospective Studies
Brain abscess Carmustine wafer Glioblastoma Neurosurgery Surgical bed cyst

Journal

Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181

Informations de publication

Date de publication:
Apr 2022
Historique:
received: 09 07 2021
accepted: 04 10 2021
revised: 16 09 2021
pubmed: 16 10 2021
medline: 6 4 2022
entrez: 15 10 2021
Statut: ppublish

Résumé

Carmustine wafers can be implanted in the surgical bed of high-grade gliomas, which can induce surgical bed cyst formation, leading to clinically relevant mass effect. An observational retrospective monocentric study was conducted including 122 consecutive adult patients with a newly diagnosed supratentorial glioblastoma who underwent a surgical resection with Carmustine wafer implantation as first line treatment (2005-2018). Twenty-two patients (18.0%) developed a postoperative contrast-enhancing cyst within the surgical bed: 16 surgical bed cysts and six bacterial abscesses. All patients with a surgical bed cyst were managed conservatively, all resolved on imaging follow-up, and no patient stopped the radiochemotherapy. Independent risk factors of formation of a postoperative surgical bed cyst were age ≥ 60 years (p = 0.019), number of Carmustine wafers implanted ≥ 8 (p = 0.040), and partial resection (p = 0.025). Compared to surgical bed cysts, the occurrence of a postoperative bacterial abscess requiring surgical management was associated more frequently with a shorter time to diagnosis from surgery (p = 0.009), new neurological deficit (p < 0.001), fever (p < 0.001), residual air in the cyst (p = 0.018), a cyst diameter greater than that of the initial tumor (p = 0.027), and increased mass effect and brain edema compared to early postoperative MRI (p = 0.024). Contrast enhancement (p = 0.473) and diffusion signal abnormalities (p = 0.471) did not differ between postoperative bacterial abscesses and surgical bed cysts. Clinical and imaging findings help discriminate between surgical bed cysts and bacterial abscesses following Carmustine wafer implantation. Surgical bed cysts can be managed conservatively. Individual risk factors will help tailor their steroid therapy and imaging follow-up.

Identifiants

DOI: 10.1007/s10143-021-01670-7 PMID: 34651215
pubmed: 34651215
doi: 10.1007/s10143-021-01670-7
pii: 10.1007/s10143-021-01670-7
doi:

Substances chimiques

Antineoplastic Agents, Alkylating 0
Carmustine U68WG3173Y

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1501-1511

Informations de copyright

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Références

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Auteurs

Alexandre Roux (A)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France.

Hichem Ammar (H)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Alessandro Moiraghi (A)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Sophie Peeters (S)

Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.

Marwan Baroud (M)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Gilles Zah-Bi (G)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Joseph Benzakoun (J)

Université de Paris, Sorbonne Paris Cité, Paris, France.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France.
Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne,, Paris, France.

Eduardo Parraga (E)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Catherine Oppenheim (C)

Université de Paris, Sorbonne Paris Cité, Paris, France.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France.
Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne,, Paris, France.

Chiara Benevello (C)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Fabrice Chretien (F)

Université de Paris, Sorbonne Paris Cité, Paris, France.
Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.

Pascale Varlet (P)

Université de Paris, Sorbonne Paris Cité, Paris, France.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France.
Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.

Frédéric Dhermain (F)

Service de Radiothérapie, Institut Gustave Roussy, Villejuif, France.

Edouard Dezamis (E)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France.

Marc Zanello (M)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France.

Johan Pallud (J)

Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France. johanpallud@hotmail.com.
Université de Paris, Sorbonne Paris Cité, Paris, France. johanpallud@hotmail.com.
UMR1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, Paris, France. johanpallud@hotmail.com.
ORCID: 0000-0002-1652-9844

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Discriminating surgical bed cysts from...
questionsmedicales.fr › Actions chimiques et utilisations › Actions toxiques › Noxas › Agents alcoylants › Antinéoplasiques alcoylants › Discriminating surgical bed cysts from...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Infections du système nerveux central › Abcès cérébral › Discriminating surgical bed cysts from...
questionsmedicales.fr › Maladies du système nerveux › Tumeurs du système nerveux › Tumeurs du système nerveux central › Tumeurs du cerveau › Discriminating surgical bed cysts from...
questionsmedicales.fr › Composés chimiques organiques › Composés nitrosés › Nitrosourées › Carmustine › Discriminating surgical bed cysts from...
questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Kystes › Discriminating surgical bed cysts from...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu nerveux › Tumeurs neuroectodermiques › Tumeurs neuroépitheliales › Gliome › Astrocytome › Glioblastome › Discriminating surgical bed cysts from...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Discriminating surgical bed cysts from...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Discriminating surgical bed cysts from...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Discriminating surgical bed cysts from...