Relationship between peritumoral edema and sedative-induced neurological deficits in patients with supratentorial glioma

doi:10.3969/j.issn.1006-7795.2023.03.017

Abstract

Abstract: Objective The study is to observe the relationship between the degree of peritumoral edema in supratentorial gliomas and sedation-induced neurological deficits to provide a reference for exploring the impact of gliomas on the functional connectivity of brain networks. Methods The study retrospectively included patients with supratentorial gliomas (frontal-temporal-parietal region) diagnosed by brain magnetic resonance imaging. All patients were also confirmed as gliomas by postoperative pathology. The Steinhoff grade of peritumoral edema was recorded, and sedative-induced neurological deficits as a brain stress test were evaluated by the National Institutes of Health Stroke Scale (NIHSS) score change. The NIHSS score change after sedation was defined as positive change (NIHSS change ≥ 2 points) and negative change (NIHSS change<2 points). The association between Steinhoff grades and sedative-induced neurological deficits was analyzed. Results Of the 76 patients enrolled, 32 (42.1%) were positive on preoperative sedative stress tests, and preoperative Steinhoff classification was not associated with test results (grade Ⅰ: 34.4% vs 40.9%; grade Ⅱ: 43.8% vs 38.6%; grade Ⅲ: 21.9% vs 20.5%, P=0.842). Patients with high-grade glioma had significant higher incidence of positive change in the brain stress test(grade Ⅱ: 40.6% vs 70.5%; grade Ⅲ-Ⅳ: 59.4% vs 29.5%, P=0.009). In addition, hospitalization costs were significantly higher in patients with positive changes ［6.65 (4.11－10.30) thousand Yuan vs 4.49 (3.46－7.13) thousand Yuan, P =0.006］, and such patients tended to have lower postoperative Karnofsky Performance Status (KPS) scores (P=0.052). Conclusion There was no significant association between the degree of peritumoral edema in patients with supratentorial glioma and the positive rate of sedative-induced neurological deficits. However, patients with positive changes in brain stress tests by sedation had significantly higher hospitalization costs and poor postoperative functional status.

Key words: glioma, peritumoral edema, sedatives, neurological function

CLC Number:

Lin Nan, Zhang Xingyue, Ma Tingting, Yin Xueke, Li Xuebin. Relationship between peritumoral edema and sedative-induced neurological deficits in patients with supratentorial glioma[J]. Journal of Capital Medical University, 2023, 44(3): 470-474.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2023.03.017

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2023/V44/I3/470

References

［1］Bryszewski B, Tybor K, Ormezowska E A, et al. Rearrangement of motor centers and its relationship to the neurological status of low-grade glioma examined on pre- and postoperative fMRI［J］. Clin Neurol Neurosurg, 2013, 115(12): 2464－2470.
［2］Fornito A, Zalesky A, Breakspear M. The connectomics of brain disorders［J］. Nat Rev Neurosci, 2015, 16(3): 159－172.
［3］Duffau H. Lessons from brain mapping in surgery for low-grade glioma: insights into associations between tumour and brain plasticity［J］. Lancet Neurol, 2005, 4(8): 476－486.
［4］Horien C, Greene A S, Constable R T, et al. Regions and connections: complementary approaches to characterize brain organization and function［J］. Neuroscientist, 2020, 26(2): 117－133.
［5］Lin N, Han R Q, Zhou J X, et al. Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner［J］. Anesthesiology, 2016, 124(3): 598－607.
［6］Lin N, Han R Q, Hui X, et al. Midazolam sedation induces upper limb coordination deficits that are reversed by flumazenil in patients with eloquent area gliomas［J］. Anesthesiology, 2019, 131(1): 36－45.
［7］Louis D N, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary［J］. Neuro Oncol, 2021, 23(8): 1231－1251.
［8］Kwah L K, Diong J. National Institutes of Health Stroke Scale (NIHSS)［J］. J Physiother, 2014, 60(1): 61.
［9］Chernik D A, Gillings D, Laine H, et al. Validity and reliability of the Observers Assessment of Alertness/Sedation Scale: study with intravenous midazolam［J］. J Clin Psychopharmacol, 1990, 10(4): 244－251.
［10］Steinhoff H, Grumme T, Kazner E, et al. Axial transverse computerized tomography in 73 glioblastomas［J］. Acta Neurochir (Wien), 1978, 42(1/2): 45－56.
［11］马婷婷, 张星月, 彭宇明, 等. 修订版美国国立卫生研究院卒中量表评估幕上占位患者镇静相关局部神经功能缺陷的诊断价值［J］. 国际麻醉学与复苏杂志, 2021, 42(10): 1046－1049.
［12］Stark A M, Stepper W, Mehdorn H M. Outcome evaluation in glioblastoma patients using different ranking scores: KPS, GOS, mRS and MRC［J］. Eur J Cancer Care (Engl), 2010, 19(1): 39－44.
［13］Roth P, Regli L, Tonder M, et al. Tumor-associated edema in brain cancer patients: pathogenesis and management［J］. Expert Rev Anticancer Ther, 2013, 13(11): 1319－1325.
［14］Claassen J A H R, Thijssen D H J, Panerai R B, et al. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation［J］. Physiol Rev, 2021, 101(4): 1487－1559.
［15］Rizk A A, Venkatraghavan L, Shankar J J S, et al. Reappearance of neurological deficits in pathologic brain: are sedatives and opioids culprits? A systematic review［J］. J Neurosurg Anesthesiol, 2022, 34(1): 14－20.
［16］Lazar R M, Berman M F, Festa J R, et al. GABAergic but not anti-cholinergic agents re-induce clinical deficits after stroke［J］. J Neurol Sci, 2010, 292(1/2): 72－76.
［17］ Zhou X Y, Li Y W, Lenahan C, et al. Glymphatic system in the central nervous system, a novel therapeutic direction against brain edema after stroke［J］. Front Aging Neurosci, 2021, 13: 698036.
［18］ Liu K W, Zhu J, Chang Y, et al. Attenuation of cerebral edema facilitates recovery of glymphatic system function after status epilepticus［J］. JCI Insight, 2021, 6(17): e151835.
［19］Tamura M, Muragaki Y, Saito T, et al. Strategy of surgical resection for glioma based on intraoperative functional mapping and monitoring［J］. Neurol Med Chir (Tokyo), 2015, 55(5): 383－398.
［20］林楠, 周建新, 韩如泉. 轻度镇静对幕上占位病人神经功能的影响与头部磁共振表现的相关因素分析［J］. 首都医科大学学报, 2017, 38(2): 313－319.

[1]	Liu Xiu, Li Wencai. Preliminary study on the effect of UNC0379 on the proliferation of glioma cells [J]. Journal of Capital Medical University, 2023, 44(5): 741-746.
[2]	Wang Kai, Yuan Leilei, Chen Qian, Ai Lin. Research progress of new radioactive tracers for cerebral glioma [J]. Journal of Capital Medical University, 2023, 44(4): 511-516.