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Morbidity and mortality of craniotomy for excision of supratentorial gliomas

Departments of Neurology (Drs. Fadul, Wood, and Posner), Neurosurgery (Drs. Galicich and Patterson), and Biostatistics (Dr. Thaler), Memorial Sloan-Kettering Cancer Center and New York Hospital-Cornell University Medical College, New York, NY. Dr. Fadul's current address is Institute Nacionale de Cancerologia, Bogota, Colombia.

Extensive surgical resection of supratentorial gliomas increases survival. However, some reports suggest that the perioperative morbidity and mortality outweigh the potential benefit of the procedure. We examined prospectively morbidity and mortality in 104 consecutive patients who underwent surgery for supratentorial glioma, as well as other factors that might affect the short-term outcome. To determine if our experience was unusual, we compared these results with those obtained from another academic neurosurgical center by a review of the records of 109 patients also treated surgically for supratentorial glioma. Mortality was 3.3% and the medical plus neurologic morbidity was 31.7%. Functionally significant neurologic worsening occurred in 42 (19.7%) patients. Complications were more frequent in patients with moderate or severe preoperative disabilities than those with mild or no preoperative disability. Patients with complete resection had fewer acute neurologic complications, and no greater risk of being neurologically impaired at 1 week, than patients with biopsy or less extensive procedures. Morbidity and mortality correlated with location: deep-midline lesions had a higher overall rate of perioperative complications (p = 0.032) and mortality (p = 0.019) and bilateral lesions a higher rate of hemorrhage (p = 0.017) and hydrocephalus (p = 0.010). Older patients (>55 years) and those receiving high daily dose of preoperative dexamethasone (24 mg) had a significantly higher risk of surgical mortality. Reoperation for recurrent tumor carried no greater risk of mortality, neurologic deterioration, and infection than a first operation. Whenever possible, maximal surgical resection should be offered to patients with supratentorial gliomas, because it does not carry a higher surgical risk than biopsy, and the long-term outcome is superior.

Address correspondence and reprint requests to Dr. Posner, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021.

Received November 5, 1987. Accepted for publication in final form January 18, 1988.

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