A Clinical Analysis of High Grade Glioma at a Tertiary Care Centre: An Observational Research
Journal Title: International Journal of Medical Research Professionals - Year 2018, Vol 4, Issue 3
Abstract
Background: Glioblastoma (GBM) is the most common and aggressive malignant brain tumor in adults. Current treatment options at diagnosis are multimodal and include surgical resection, radiation, and chemotherapy. High grade glioma is the most frequent primary brain tumor in adults, and accounts for most of the primary brain tumor cases diagnosed each year. Significant advances in the understanding of the molecular pathology of GBM and associated cell signaling pathways have opened opportunities for new therapies for recurrent and newly diagnosed disease. Innovative treatments, such as tumor-treating fields (TTFields) and immunotherapy, give hope for enhanced survival. Aims: Prospectively study the surgical outcome in cases of high grade glioma (glioblastoma multiforme & its variants) Methods and Materials: In present study all patients who underwent craniotomy and excision / decompression of high grade glioma (glioblastoma multiforme & its variants) during the period of october 2014 to January 2017 were included for the prospective analysis. Age, gender, clinical features, radiological features, extent of resection, adjuvant therapy and clinical outcome were considered for the analysis. Tumor removal was considered complete / near total if the surgeon was convinced that there had been complete removal and if postoperative contrast-enhanced MR imaging showed no evidence of residual tumor. Removal was considered subtotal when only a small portion of residual tumor remained because of firm attachment to vascular or neural structures or when postoperative imaging revealed a small contrast- enhancing or calcified area. Results: The maximum incidence (70%) of High Grade Gliomas (GBM) is in 4th to 6th decade, with fairely uncommon in children. Male are more affected than female with ratio of 1.7:1. Usually the time period of starting of symptoms is 5 months or more than that, with headache (74%) being most common complaint, followed by convulsions and limb weakness. Papilloedema was the most common sign (62%) followed by limb weakness (40%). Postoperatively 85% patients with papilloedema recovered in average 1.5 months. Those having neurological deficit may have involvement of cranial nerve, with maximum 66% optic nerve involvement, mostly because of raised I.C.T or occasionally tumor compression over the nerve. This usually presented as papilloedema in fundus examination. CT scan as wells as MRI are the two most important tool of diagnosis; M.R.I has the added advantage of better soft tissue details, which help in planning operative strategy. High grade gliomas (GBM) are most common (96%) in Supratentorial subcortical location. Diencephalic (8%) and Posterior fossa GBM are less common, 4% in our study. We found Intraoperative Ultrasonography of great help in localization of tumor and evaluation of extent of resection. The neurological morbidity (20%) and mortality (4%) associated in our study mainly comprises of this group.
Authors and Affiliations
Tushar V. Soni, Bhagirath P. More
Keywords
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- EP ID EP532025
- DOI 10.21276/ijmrp.2018.4.3.044
- Views 87
- Downloads 0
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