| 1. |
- Haraldseide, Lisa Marie, et al.
(författare)
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Does preoperative health-related quality of life predict survival in high-grade glioma patients? - a prospective study.
- 2020
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Ingår i: British journal of neurosurgery. - : Informa UK Limited. - 1360-046X .- 0268-8697. ; 34:1, s. 28-34
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore if preoperative patient-reported health-related quality of life (HRQoL) provides additional prognostic value as a supplement to other preoperatively known clinical factors in patients with high-grade glioma (HGG).Methods: In a prospective explorative study, 114 patients with high-grade glioma were included. The participants completed the generic HRQoL questionnaire EQ-5D 3L, and the disease-specific questionnaires EORTC QLQ-C30 and EORTC QLQ-BN20 1-3days before surgery. Operating neurosurgeons scored the patient's preoperative functional level by using Karnofsky Performance Status (KPS). Univariate and multivariate Cox regression analyses were performed to identify HRQoL domains that were associated with survival. Kaplan-Meier survival curves and Log-rank tests were used to visualize differences in survival between groups.Results: In addition to preoperative KPS and age, the EORTC QLQ-BN20 subdomains 'seizures' (HR 0.98, p<.006), 'itchy skin' (HR 1.01, p<.036) and 'bladder control' (HR 1.01, p<.023) were statistically significant independent predictors of survival in a multivariate cox model.Conclusions: Our results suggest that in patients with HGG, certain preoperative symptom scales within EORTC QLQ-BN20 may provide additional prognostic information to supplement other clinical prognostic factors. However, further studies are required to validate our findings. Overall the instruments EQ-5D 3L and EORTC QLQ-C30 do not seem to provide much additional valuable prognostic information to already known prognostic factors.
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| 2. |
- Drewes, Christina, et al.
(författare)
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Perioperative and postoperative quality of life in glioma patients - A longitudinal cohort study.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- Few studies assess patient-reported quality of life (QoL) in glioma patients undergoing surgery, and even fewer provide longitudinal data. Accordingly, there is little knowledge about the changes of QoL over time in glioma patients. We sought to explore peri- and postoperative development of generic QoL during the first six months after primary glioma surgery.136 adult patients undergoing primary surgery for high-grade (HGG) or low-grade (LGG) glioma were prospectively included in this explorative, longitudinal study. Patient-reported QoL was measured with the generic tool EQ-5D 3L preoperatively and at 1 and 6 months after surgery.At group level, there was no difference in EQ-5D index values in patients with HGG compared to patients with LGG at baseline or at 1 month. At 6 months, EQ-5D index values in HGG patients had deteriorated significantly (p<0.001), but remained stable in LGG patients. Individual level QoL development was more diverse. American Society of Anesthesiology class ≥3, resection grades other than gross total resection (GTR) and HGG were identified as independent predictors for negative development of QoLbetween 1 and 6 months after surgery.At group level, development of generic QoL between baseline and 1 and 6 months postoperatively seems to follow the natural disease trajectories of LGG and HGG, with deterioration in HGG patients at 6 months. Individual development of QoL is heterogeneous. HGG, resection grades other than GTR and preoperative comorbidity are predictors of postoperative QoL-impairment.
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| 3. |
- Fyllingen, Even Hovig, et al.
(författare)
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Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort.
- 2021
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Ingår i: Acta neurochirurgica. - : Springer Science and Business Media LLC. - 0942-0940 .- 0001-6268. ; 163, s. 1895-1905
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies on the effect of tumor location on overall survival in glioblastoma have found conflicting results. Based on statistical maps, we sought to explore the effect of tumor location on overall survival in a population-based cohort of patients with glioblastoma and IDH wild-type astrocytoma WHO grade II-III with radiological necrosis.Patients were divided into three groups based on overall survival: < 6 months, 6-24 months, and > 24 months. Statistical maps exploring differences in tumor location between these three groups were calculated from pre-treatment magnetic resonance imaging scans. Based on the results, multivariable Cox regression analyses were performed to explore the possible independent effect of centrally located tumors compared to known prognostic factors by use of distance from center of the third ventricle to contrast-enhancing tumor border in centimeters as a continuous variable.A total of 215 patients were included in the statistical maps. Central tumor location (corpus callosum, basal ganglia) was associated with overall survival < 6 months. There was also a reduced overall survival in patients with tumors in the left temporal lobe pole. Tumors in the dorsomedial right temporal lobe and the white matter region involving the left anterior paracentral gyrus/dorsal supplementary motor area/medial precentral gyrus were associated with overall survival > 24 months. Increased distance from center of the third ventricle to contrast-enhancing tumor border was a positive prognostic factor for survival in elderly patients, but less so in younger patients.Central tumor location was associated with worse prognosis. Distance from center of the third ventricle to contrast-enhancing tumor border may be a pragmatic prognostic factor in elderly patients.
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| 4. |
- Hosainey, Sayied Abdol Mohieb, et al.
(författare)
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Are there predilection sites for intracranial meningioma? A population-based atlas.
- 2022
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Ingår i: Neurosurgical review. - : Springer Science and Business Media LLC. - 1437-2320. ; 45:2, s. 1543-1552
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Tidskriftsartikel (refereegranskat)abstract
- Meningioma is the most common benign intracranial tumor and is believed to arise from arachnoid cap cells of arachnoid granulations. We sought to develop a population-based atlas from pre-treatment MRIs to explore the distribution of intracranial meningiomas and to explore risk factors for development of intracranial meningiomas in different locations. All adults (≥18years old) diagnosed with intracranial meningiomas and referred to the department of neurosurgery from a defined catchment region between 2006 and 2015 were eligible for inclusion. Pre-treatment T1 contrast-enhanced MRI-weighted brain scans were used for semi-automated tumor segmentation to develop the meningioma atlas. Patient variables used in the statistical analyses included age, gender, tumor locations, WHO grade and tumor volume. A total of 602 patients with intracranial meningiomas were identified for the development of the brain tumor atlas from a wide and defined catchment region. The spatial distribution of meningioma within the brain is not uniform, and there were more tumors in the frontal region, especially parasagittally, along the anterior part of the falx, and on the skull base of the frontal and middle cranial fossa. More than 2/3 meningioma patients were females (p<0.001) who also were more likely to have multiple meningiomas (p<0.01), while men more often have supratentorial meningiomas (p<0.01). Tumor location was not associated with age or WHO grade. The distribution of meningioma exhibits an anterior to posterior gradient in the brain. Distribution of meningiomas in the general population is not dependent on histopathological WHO grade, but may be gender-related.
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| 5. |
- Jakola, Asgeir Store, et al.
(författare)
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Advancements in predicting outcomes in patients with glioma: a surgical perspective.
- 2020
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Ingår i: Expert review of anticancer therapy. - : Informa UK Limited. - 1744-8328 .- 1473-7140. ; 20:3, s. 167-177
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Diffuse glioma is a challenging neurosurgical entity. Although surgery does not provide a cure, it may greatly influence survival, brain function, and quality of life. Surgical treatment is by nature highly personalized and outcome prediction is very complex. To engage and succeed in this balancing act it is important to make best use of the information available to the neurosurgeon.Areas covered: This narrative review provides an update on advancements in predicting outcomes in patients with glioma that are relevant to neurosurgeons.Expert opinion: The classical 'gut feeling' is notoriously unreliable and better prediction strategies for patients with glioma are warranted. There are numerous tools readily available for the neurosurgeon in predicting tumor biology and survival. Predicting extent of resection, functional outcome, and quality of life remains difficult. Although machine-learning approaches are currently not readily available in daily clinical practice, there are several ongoing efforts with the use of big data sets that are likely to create new prediction models and refine the existing models.
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| 6. |
- Jakola, Asgeir Store, et al.
(författare)
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Is there a response shift in generic health-related quality of life 6months after glioma surgery?
- 2017
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Ingår i: Acta neurochirurgica. - : Springer Science and Business Media LLC. - 0942-0940 .- 0001-6268. ; 59:2, s. 377-84
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Tidskriftsartikel (refereegranskat)abstract
- Patients may recalibrate internal standards when faced with a serious diagnosis or neurological deficits. This so-called response shift is important to understand in longitudinal health-related quality of life (HRQoL) data, but this is not quantitatively assessed in glioma patients.Patients with gliomas were eligible for this HRQoL study. We used EuroQol-5D 3L to assess generic HRQoL with assessment preoperatively and at 6months postoperatively. At time of follow-up, patients scored how they considered their baseline HRQoL in retrospect using the same questionnaire ("then-test").Seventy-three patients were enrolled between January 2013 and September 2015. With the then-test approach, the mean EQ-5D 3L index was similar compared to baseline (0.77, mean difference 0.01, 95% CI -0.57 to 0.07, p=0.82). Also, then-test and baseline VAS score were similar (mean difference 0, 95% CI -7 to 7, p=0.97). However, a 0.10-0.13 difference from baseline was observed in patients that improved or deteriorated in HRQoL at follow-up according to the then-test EQ-5D 3L index value. The direction of change as observed from the then-test was similar to the direction of clinicalchange, reducing the impact of any HRQoL change from baseline to follow-up.On average, we observed no response shift using EQ-5D 3L in the selection of glioma patients able to participate at 6months after surgery. However, following change in HRQoL at follow-up, response shift seems to reduce the effects of HRQoL changes by lowering of internal standards in patients that deteriorate and raising the standards in patients that improve.
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| 7. |
- Jakola, Asgeir Store, et al.
(författare)
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Spatial distribution of malignant transformation in patients with low-grade glioma.
- 2020
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Ingår i: Journal of neuro-oncology. - : Springer Science and Business Media LLC. - 1573-7373 .- 0167-594X. ; 146, s. 373-380
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Tidskriftsartikel (refereegranskat)abstract
- Malignant transformation represents the natural evolution of diffuse low-grade gliomas (LGG). This is a catastrophic event, causing neurocognitive symptoms, intensified treatment and premature death. However, little is known concerning the spatial distribution of malignant transformation in patients with LGG.Patients histopathological diagnosed with LGG and subsequent radiological malignant transformation were identified from two different institutions. We evaluated the spatial distribution of malignant transformation with (1) visual inspection and (2) segmentations of longitudinal tumor volumes. In (1) a radiological transformation site<2cm from the tumor on precedingMRI was defined local transformation. In (2) overlap with pretreatment volume after importation into a common space was defined as local transformation. With a centroid model we explored if there were particular patterns of transformations within relevant subgroups.We included 43 patients in the clinical evaluation, and 36 patients had MRIs scans available for longitudinal segmentations. Prior to malignant transformation, residual radiological tumor volumes were>10ml in 93% of patients. The transformation site was considered local in 91% of patients by clinical assessment. Patients treated with radiotherapy prior to transformation had somewhat lower rate of local transformations (83%). Based upon the segmentations, the transformation was local in 92%. We did not observe any particular pattern of transformations in examined molecular subgroups.Malignant transformation occurs locally and within the T2w hyperintensities in most patients. Although LGG is an infiltrating disease, this data conceptually strengthens the role of loco-regional treatments in patients with LGG.
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| 8. |
- Majewska, Paulina, et al.
(författare)
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Passive or active drainage system for chronic subdural haematoma-a single-center retrospective follow-up study.
- 2024
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Ingår i: Acta neurochirurgica. - 0942-0940. ; 166:1
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative drainage systems have become a standard treatment for chronic subdural hematoma (CSDH). We previously compared treatment results from three Scandinavian centers using three different postoperative drainage systems and concluded that the active subgaleal drainage was associated with lower recurrence and complication rates than the passive subdural drainage. We consequently changed clinical practice from using the passive subdural drainage to the active subgaleal drainage.The aim of the present study was to assess a potential change in reoperation rates for CSDH after conversion to the active subgaleal drainage.This single-center cohort study compared the reoperation rates for recurrent same-sided CSDH and postoperative complication rates between patients treated during two study periods (passive subdural drainage cohort versus active subgaleal drainage cohort).In total, 594 patients were included in the study. We found no significant difference in reoperation rates between the passive subdural drain group and the active subgaleal drain group (21.6%, 95% CI 17.5-26.4% vs. 18.0%, 95% CI 13.8-23.2%; p=0.275). There was no statistical difference in the rate of serious complications between the groups. The operating time was significantly shorter for patients operated with the active subgaleal drain than patients with the passive subdural drain (32.8min, 95% CI 31.2-34.5min vs. 47.6min, 95% CI 44.7-50.4min; p<0.001).Conversion from the passive subdural to the active subgaleal drainage did not result in a clear reduction of reoperation rates for CSDH in our center.
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| 9. |
- Majewska, Paulina, et al.
(författare)
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What is the current clinico-radiological diagnostic accuracy for intracranial tumours?
- 2021
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 144:2, s. 142-148
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Tidskriftsartikel (refereegranskat)abstract
- To determine the diagnostic accuracy of routine clinico-radiological workup for a population-based selection of intracranial tumours.In this prospective cohort study, we included consecutive adult patients who underwent a primary surgical intervention for a suspected intracranial tumour between 2015 and 2019 at a single-neurosurgical centre. The treating team estimated the expected diagnosis prior to surgery using predefined groups. The expected diagnosis was compared to final histopathology and the accuracy of preoperative clinico-radiological diagnosis (sensitivity, specificity, positive and negative predictive values) was calculated.392 patients were included in the data analysis, of whom 319 underwent a primary surgical resection and 73 were operated with a diagnostic biopsy only. The diagnostic accuracy varied between different tumour types. The overall sensitivity, specificity and diagnostic mismatch rate of clinico-radiological diagnosis was 85.8%, 97.7% and 4.0%, respectively. For gliomas (including differentiation between low-grade and high-grade gliomas), the same diagnostic accuracy measures were found to be 82.2%, 97.2% and 5.6%, respectively. The most common diagnostic mismatch was between low-grade gliomas, high-grade gliomas and metastases. Accuracy of 90.2% was achieved for differentiation between diffuse low-grade gliomas and high-grade gliomas.The current accuracy of a preoperative clinico-radiological diagnosis of brain tumours is high. Future non-invasive diagnostic methods need to outperform our results in order to add much value in a routine clinical setting in unselected patients.
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| 10. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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Pre- and postoperative headache in patients with intracranial tumors.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- We sought to examine prevalence of headache in patients with histopathologically verified intracranial tumors scheduled for surgery, and assess change in headache 1 and 6 months after surgical resection. Possible tumor and patient related predictors for preoperative headache and early postoperative symptom relief were also explored.The European Organization for Research and Treatment of Cancer (EORTC) has developed a quality of life questionnaire (EORTC QLQ-C30) with a brain cancer specific module, QLQ-BN20, containing 20 questions rating symptoms the past week on an ordinal scale ranging from 1-4. Analyses are based on question 4 in this questionnaire.In this prospective population based cohort study of 507 patients we found that headache is a frequent symptom in patients with intracranial neoplasms. 52% reported some degree of preoperative headache, and the prevalence dropped to 43% and 30% 1 and 6 months postoperatively. 19% and 9% reported postoperative worsening or new headache 1 and 6 months after surgery. Younger age, female gender and occipital tumor location were significant predictors for both preoperative headache and early postoperative relief. Additionally, Karnofsky Performance Status (KPS) below 70 was a predictor for headache relief 1 month after surgery. No independent risk factors for worsening or new headache after surgery were identified.Headache is a common symptom in patients with intracranial tumors, especially in younger and female patients. Many patients experience improvement after surgery, and younger age, female gender, occipital tumor location and functional dependence were identified as factors associated with early postoperative headache relief.
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| 11. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- In glioma operations, we sought to analyze sensitivity, specificity and predictive values of intraoperative 3D ultrasound (US) for detecting residual tumor compared to early postoperative MR imaging. Factors possibly associated with radiological complete resection were also explored.144 operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based single institution series. Operating surgeons filled out a questionnaire immediately after surgery, stating if residual tumor was seen with US at the end of resection and rated US image quality (good, medium, poor). Extent of surgical resection was estimated from pre- and postoperative MRI images.Overall specificity was 85% for "no tumor remnant" seen in US images at the end of resection as compared to postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median 1.05 ml) in operations with false negative US findings. Specificity was highest in low-grade glioma operations (94%), and lowest in patients who had previously undergone radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, while good ultrasound image quality did not reach statistical significance (p = 0.061).The specificity of intraoperative US is rather good, but sensitivity for detecting the last milliliter is low compared to postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, while ultrasound image quality was not.
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| 12. |
- Rubin, Maja Chava, et al.
(författare)
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Primary versus recurrent surgery for glioblastoma-a prospective cohort study.
- 2022
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Ingår i: Acta neurochirurgica. - : Springer Science and Business Media LLC. - 0942-0940 .- 0001-6268. ; 164:2, s. 429-438
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Tidskriftsartikel (refereegranskat)abstract
- There is currently limited evidence for surgery in recurrent glioblastoma (GBM). Our aim was to compare primary and recurrent surgeries, regarding changes in perioperative, generic health-related quality of life (HRQoL), complications, extents of resection and survival.Between 2007 and 2018, 65 recurrent and 160 primary GBM resections were prospectively enrolled. HRQoL was recorded with EQ-5D 3L preoperatively and at 1month postoperatively. Median perioperative change in HRQoL and change greater than the minimal clinically important difference (MCID) were assessed. Tumour volume and extent of resection were obtained from pre- and postoperative MRI scans. Survival was assessed from date of surgery.Comparing recurrent surgeries and primary resections, most variables were balanced at baseline, but median age (59 vs. 62, p=0.005) and median preoperative tumour volume (14.9 vs. 25.3ml, p=0.001) were lower in recurrent surgeries. There were no statistically significant differences regarding complication rates, neurological deficits, extents of resection or EQ-5D 3L index values at baseline and at follow-up. Twenty (36.4%) recurrent resections vs. 39 (27.5%) primary resections reported clinically significant deterioration in HRQoL at follow-up. Stratified by clinically significant change in EQ-5D 3L, the survival distributions were not statistically significantly different in either group. Survival was associated with extent of resection (p=0.015) in recurrent surgeries only.Outcomes after primary and recurrent surgeries were quite similar in our practice. As surgery may prolong life in patients where gross total resection is obtainable with reasonable risk, the indication for surgery in GBM should perhaps not differ that much in primary and recurrent resections.
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| 13. |
- Sagberg, Lisa Millgård, et al.
(författare)
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Brain atlas for assessing the impact of tumor location on perioperative quality of life in patients with high-grade glioma: A prospective population-based cohort study.
- 2019
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Ingår i: NeuroImage. Clinical. - : Elsevier BV. - 2213-1582. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Tumor location is important for surgical decision making. Particular attention is paid to regions that contain sensorimotor and language functions, but it is unknown if these are the most important regions from the patients' perspective.To develop an atlas for depicting and assessing the potential importance of tumor location for perioperative health-related quality of life (HRQoL) in patients with newly diagnosed high-grade glioma.Patient-reported HRQoL data and semi-automatically segmented preoperative 3D MRI-images were combined in 170 patients. The images were registered to a standardized space where the individual tumors were given the values and color intensity of the corresponding HRQoL. Descriptive brain maps of HRQoL, defined quantitative analyses, and voxel-based lesion symptom mapping comparing patients with tumors in different locations were made.There was no statistical difference in overall perioperative HRQoL between patients with tumors located in left or right hemisphere, between patients with tumors in different lobes, or between patients with tumors located in non-eloquent, near eloquent, or eloquent areas. Patients with tumors involving the internal capsule, and patients with preoperative motor symptoms and postoperative motor deficits, reported significantly worse overall HRQoL-scores.The impact of anatomical tumor location on overall perioperative HRQoL seems less than frequently believed, and the distinction between critical and less critical brain regions seems more unclear according to the patients than perhaps when judged by physicians. However, worse HRQoL was found in patients with tumors in motor-related regions, indicating that these areas are crucial also from the patients' perspective.
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| 14. |
- Sagberg, Lisa Millgård, et al.
(författare)
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How well do neurosurgeons predict survival in patients with high-grade glioma?
- 2022
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Ingår i: Neurosurgical review. - : Springer Science and Business Media LLC. - 1437-2320 .- 0344-5607. ; 45:1, s. 865-872
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Tidskriftsartikel (refereegranskat)abstract
- Due to the lack of reliable prognostic tools, prognostication and surgical decisions largely rely on the neurosurgeons' clinical prediction skills. The aim of this study was to assess the accuracy of neurosurgeons' prediction of survival in patients with high-grade glioma and explore factors possibly associated with accurate predictions. In a prospective single-center study, 199 patients who underwent surgery for high-grade glioma were included. After surgery, the operating surgeon predicted the patient's survival using an ordinal prediction scale. A survival curve was used to visualize actual survival in groups based on this scale, and the accuracy of clinical prediction was assessed by comparing predicted and actual survival. To investigate factors possibly associated with accurate estimation, a binary logistic regression analysis was performed. The surgeons were able to differentiate between patients with different lengths of survival, and median survival fell within the predicted range in all groups with predicted survival<24months. In the group with predicted survival>24months, median survival was shorter than predicted. The overall accuracy of surgeons' survival estimates was 41%, and over- and underestimations were done in 34% and 26%, respectively. Consultants were 3.4 times more likely to accurately predict survival compared to residents (p=0.006). Our findings demonstrate that although especially experienced neurosurgeons have rather good predictive abilities when estimating survival in patients with high-grade glioma on the group level, they often miss on the individual level. Future prognostic tools should aim to beat the presented clinical prediction skills.
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| 15. |
- Sagberg, Lisa Millgård, et al.
(författare)
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Is intracranial volume a risk factor for IDH-mutant low-grade glioma? A case-control study.
- 2022
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Ingår i: Journal of neuro-oncology. - : Springer Science and Business Media LLC. - 1573-7373 .- 0167-594X. ; 160:101–106
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Tidskriftsartikel (refereegranskat)abstract
- Risk of cancer has been associated with body or organ size in several studies. We sought to investigate the relationship between intracranial volume (ICV) (as a proxy for lifetime maximum brain size) and risk of IDH-mutant low-grade glioma.In a multicenter case-control study based on population-based data, we included 154 patients with IDH-mutant WHO grade 2 glioma and 995 healthy controls. ICV in both groups was calculated from 3D MRI brain scans using an automated reverse brain mask method, and then compared using a binomial logistic regression model.We found a non-linear association between ICV and risk of glioma with increasing risk above and below a threshold of 1394ml (p<0.001). After adjusting for ICV, sex was not a risk factor for glioma.Intracranial volume may be a risk factor for IDH-mutant low-grade glioma, but the relationship seems to be non-linear with increased risk both above and below a threshold in intracranial volume.
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| 16. |
- Schei, Stine, et al.
(författare)
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Perioperative fatigue in patients with diffuse glioma.
- 2020
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Ingår i: Journal of neuro-oncology. - : Springer Science and Business Media LLC. - 1573-7373 .- 0167-594X. ; 147, s. 97-107
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have assessed fatigue in relation to glioma surgery. The purpose of this study was to explore the prevalence of pre- and postoperative high fatigue, perioperative changes, and factors associated with pre- and postoperative high fatigue in patients undergoing primary surgery for diffuse glioma.A total of 112 adult patients were prospectively included. Patient-reported fatigue was assessed before and one month after surgery using the cancer-specific European Organization for Research and Treatment of Cancer questionnaire fatigue subscale. The scores were dichotomized as high fatigue (≥39) or low fatigue (<39). A change in score of ≥10 was considered as a clinically significant change. Factors associated with pre- and postoperative high fatigue were explored in multivariable regression analyses.High fatigue was reported by 45% of the patients preoperatively and by 42% of the patients postoperatively. Female gender and low Karnofsky Performance Status (KPS) were associated with preoperative high fatigue, while postoperative complications, low KPS and low-grade histopathology were associated with postoperative high fatigue. In total 35/92 (38%) patients reported a clinically significant improvement of fatigue scores after surgery, 36/92 (39%) patients reported a clinically significant worsening of fatigue scores after surgery, and 21/92 (23%) patients reported no clinically significant change in fatigue scores after surgery. Patients with low-grade gliomas more often reported low fatigue before surgery and high fatigue after surgery, while patients with high-grade gliomas more often reported high fatigue before surgery and low fatigue after surgery.Our findings indicate that fatigue is a common symptom in patients with diffuse glioma, both pre- and postoperatively. Perioperative changes were frequently seen. This is important knowledge when informing patients before and after surgery.
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| 17. |
- Sjåvik, Kristin, et al.
(författare)
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Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study.
- 2020
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Ingår i: Journal of neurosurgery. - 1933-0693. ; 133:4, s. 1113-1119
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Surgery for chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedures. The benefit of postoperative passive subdural drainage compared with no drains has been established, but other drainage techniques are common, and their effectiveness compared with passive subdural drains remains unknown. METHODS In Scandinavian population-based cohorts the authors conducted a consecutive, parallel cohort study to compare different drainage techniques. The techniques used were continuous irrigation and drainage (CID cohort, n = 166), passive subdural drainage (PD cohort, n = 330), and active subgaleal drainage (AD cohort, n = 764). The primary end point was recurrence in need of reoperation within 6 months of index surgery. Secondary end points were complications, perioperative mortality, and overall survival. The analyses were based on direct regional comparison (i.e., surgical strategy). RESULTS Recurrence in need of surgery was observed in 18 patients (10.8%) in the CID cohort, in 66 patients (20.0%) in the PD cohort, and in 85 patients (11.1%) in the AD cohort (p < 0.001). Complications were more common in the CID cohort (14.5%) compared with the PD (7.3%) and AD (8.1%) cohorts (p = 0.019). Perioperative mortality rates were similar between cohorts (p = 0.621). There were some differences in baseline and treatment characteristics possibly interfering with the above-mentioned results. However, after adjusting for differences in baseline and treatment characteristics in a regression model, the drainage techniques were still significantly associated with clinical outcome (p < 0.001 for recurrence, p = 0.017 for complications). CONCLUSIONS Compared with the AD cohort, more recurrences were observed in the PD cohort and more complications in the CID cohort, also after adjustment for differences at baseline. Although the authors cannot exclude unmeasured confounding factors when comparing centers, AD appears superior to the more common PD. Clinical trial registration no.: NCT01930617 (clinicaltrials.gov).
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| 18. |
- Strand, Per Sveino, et al.
(författare)
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Growth dynamics of untreated meningiomas.
- 2024
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Ingår i: Neuro-oncology advances. - 2632-2498. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge about meningioma growth characteristics is needed for developing biologically rational follow-up routines. In this study of untreated meningiomas followed with repeated magnetic resonance imaging (MRI) scans, we studied growth dynamics and explored potential factors associated with tumor growth.In a single-center cohort study, we included 235 adult patients with radiologically suspected intracranial meningioma and at least 3 MRI scans during follow-up. Tumors were segmented using an automatic algorithm from contrast-enhanced T1 series, and, if needed, manually corrected. Potential meningioma growth curves were statistically compared: linear, exponential, linear radial, or Gompertzian. Factors associated with growth were explored.In 235 patients, 1394 MRI scans were carried out in the median 5-year observational period. Of the models tested, a Gompertzian growth curve best described growth dynamics of meningiomas on group level. 59% of the tumors grew, 27% remained stable, and 14% shrunk. Only 13 patients (5%) underwent surgery during the observational period and were excluded after surgery. Tumor size at the time of diagnosis, multifocality, and length of follow-up were associated with tumor growth, whereas age, sex, presence of peritumoral edema, and hyperintense T2-signal were not significant factors.Untreated meningiomas follow a Gompertzian growth curve, indicating that increasing and potentially doubling subsequent follow-up intervals between MRIs seems biologically reasonable, instead of fixed time intervals. Tumor size at diagnosis is the strongest predictor of future growth, indicating a potential for longer follow-up intervals for smaller tumors. Although most untreated meningiomas grow, few require surgery.
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| 19. |
- Viken, Heidi Heitmann, et al.
(författare)
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When are complications following brain tumor surgery detected?
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750.
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Tidskriftsartikel (refereegranskat)abstract
- To optimize follow-up and surveillance routines after intracranial surgery, knowledge about when complications occur is needed. We sought to explore when postoperative complications are detected after brain tumor surgery, and assess the severity of these.We did a retrospective review of hospital records in 1291 adult patients undergoing elective craniotomy for intracranial tumors between 2008-2016 at our institution. Medical history, comorbidity, registered outcomes within 30 days and time of detection of complications were registered. The severity and nature of complications were graded using the Landriel classification system.708 complications were registered in 465 (36.0%) operations within the first 30 days. 30.6% experienced mild or moderate complications (grade I-II), 5.4% experienced severe or fatal complications (grade III-IV). 5.7% (n=74) developed complications within 24 h. 45.7% of severe and fatal complications and 8.6% of mild and moderate complications were detected within 24 h, while 77.1% and 57.5%, respectively, were detected within one week. Multivariate analysis revealed that Karnofsky Performance Status < 70 and longer duration of surgery were factors associated with developing severe or fatal complications.Mild and moderate complications, dominated by extracranial infections such as urinary tract infections and pneumonias are very common after intracranial tumor surgery. Detection rates for mild and moderate complications are probably much affected by local routines for surveillance, screening, discharge, documentation, and follow up, perhaps limiting usefulness as a quality measure. Severe and fatal complications are mainly detected in the early postoperative course.
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