Ventricular opening in High-Grade Glioma surgery. Impact on surgical, functional outcomes, and survival rates. Experience in a Latin-American center

Abstract

Objective: Analyze the impact of ventricular opening during surgery for High-Grade Glioma (HGG) on surgical, functional outcomes, and survival rates.

Materials and methods: Retrospective, single-center, analytical study of a cohort of patients who underwent surgery for HGG in an Argentine center between 2013 and 2023. Patients with Grade IV supratentorial gliomas, 3 months of minimum follow-up, studied with pre and postoperative volumetric MRI were included. Subsequently, ventricular opening during surgery and its influence on prognosis were analyzed.

Results: A total 263 patients met the inclusion criteria, with a mean follow-up of 24.8 months. Mean age was 58.5 years with a predominance of male patients (63 %) and preoperative mean KPS was 80 (range 40-100). Eighty-eight percent of tumors corresponded to Glioblastomas and the mean preoperative volume was 27.2 cm3. Ventricular opening was identified in 80 patients (30.4 %) in correlation with the number of patients with ependymal invasion. This factor was associated with worse survival rates and risk of multicentricity in univariate analysis. However, when adjusted for covariables, there was a trend towards higher survival and slight increase in resection rates. Opening the ventricles was associated with a higher risk of leptomeningeal spread and complications such as hydrocephalus and CSF leak.

Conclusion: Ventricular opening during surgery for HGG did not show to represent an independent prognostic factor for survival rates. It could be considered when ependymal invasion is observed in favor of maximizing EOR. Conversely, it should be avoided as it carries a higher risk for complications and tumor spread.