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PURPOSE: To assess changes in modified Raymond-Roy classification (MRRC) occlusion classes and recurrence rates over time and evaluate recurrence-free survival after coil embolization and its predictors. MATERIALS AND METHODS: During 2007-2016, 201 patients (mean age, 57.1 ± 13.4 years; 75.5% women) with 240 aneurysms treated with coil embolization were enrolled. MRRC Class I (n = 210), Class II (n = 14), Class IIIa (n = 10), and Class IIIb (n =6) closures were assessed. Recurrence was defined as recanalization in MRRC Class I closures or an increase of at least 20% in any of the dimensions of the remnants of the other classes. Recurrence-free survival and its predictors were analyzed using survival analysis. RESULTS: Most changes in MRRC class occurred in the first year after treatment. MRRC Class I closures had a slightly lower probability of change than that associated with other classes within 1-5 years, whereas Class IIIb closures remained unchanged. Rates of recurrence or regression for all classes were highest within the first year. The median recurrence-free survival times among patients with Class IIIa and Class IIIb closures were 11.56 and 5.55 months, respectively. Significant predictors of recurrence included aneurysm size of 13-24 mm, ruptured or wide-necked aneurysms, and MRRC Class IIIa or IIIb closures. CONCLUSIONS: Class changes and recurrence rates for all MRRC classes were highest in the first year. MRRC Class IIIb closures had the highest recurrence rate and the shortest recurrence-free survival. Recurrence risk increased in Classes IIIa and IIIb and with large, ruptured or wide-necked aneurysms.

Asunto(s)

Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Masculino , Estudios de Seguimiento , Resultado del Tratamiento , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Estudios Retrospectivos , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos

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Preoperative assessment of surgery using high-quality images can help surgeons to achieve best result of treatment. With the advances in computer technology, interactive multimodality fusion images have been developed. The use of fusion images as a preoperative planning tool is described with its examples in illustrative cases of trigeminal neuralgia and hemifacial spasm microvascular decompression (MVD). Interactive computer graphics such as multimodality fusion method is a useful tool to preoperatively predict the need of bone exposure and configuration of blood vessels with its correlation to cranial nerves in MVD.

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BACKGROUND: Genomic-based tools have been used to predict poor prognosis high-grade glioma (HGG). As genetic technologies are not generally available in countries with limited resources, clinical parameters may be still necessary to use in predicting the prognosis of the disease. This study aimed to identify prognostic factors associated with survival of patients with HGG. We also proposed a validated nomogram using clinical parameters to predict the survival of patients with HGG. METHODS: A multicenter retrospective study was conducted in patients who were diagnosed with anaplastic astrocytoma (WHO III) or glioblastoma (WHO IV). Collected data included clinical characteristics, neuroimaging findings, treatment, and outcomes. Prognostic factor analysis was conducted using Cox proportional hazard regression analysis. Then, we used the significant prognostic factors to develop a nomogram. A split validation of nomogram was performed. Twenty percent of the dataset was used to test the performance of the developed nomogram. RESULTS: Data from 171 patients with HGG were analyzed. Overall median survival was 12 months (interquartile range: 5). Significant independent predictors included frontal HGG (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.40-0.60), cerebellar HGG (HR: 4.67; 95% CI: 0.93-23.5), (HR: 1.55; 95% CI: 1.03-2.32; reference = total resection), and postoperative radiotherapy (HR: 0.18; 95% CI: 0.10-0.32). The proposed nomogram was validated using nomogram's predicted 1-year mortality rate. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve of our nomogram were 1.0, 0.50, 0.45, 1.0, 0.64, and 0.75, respectively. CONCLUSION: We developed a nomogram for individually predicting the prognosis of HGG. This nomogram had acceptable performances with high sensitivity for predicting 1-year mortality.

Asunto(s)

Neoplasias Encefálicas/mortalidad , Glioma/mortalidad , Neuroimagen/métodos , Nomogramas , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Femenino , Estudios de Seguimiento , Glioma/patología , Glioma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia

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BACKGROUND: The principles of endovascular treatment of bilateral cavernous sinus dural arteriovenous fistula (CS-dAVF) are not well established because of the complexity in the number of fistula tracts and their behavior, which seems to be more aggressive. We aimed to determine an efficient technique for endovascular treatment of bilateral CS-dAVF and the associated factors to achieve good clinical and angiographic outcomes. METHODS: The data were analyzed from 165 consecutive patients diagnosed with CS-dAVF from January 2005 to September 2018. The demographic data included approaching route, embolization times, embolization material, sequence of embolization, number of embolization sessions, and angiographic and clinical outcomes. Interrater agreement of bilateral CS-dAVF diagnosis was performed using the κ coefficient. The factors associated with treatment outcome were analyzed using a Pearson χ2 test. RESULTS: Bilateral CS-dAVF was detected in 43 patients (26%). Angiographic presentations that showed evidence of sinus thrombosis, dangerous venous drainage, and higher Satomi classification were more commonly found in bilateral CS-dAVF than in unilateral CS-dAVF. Good clinical outcome and cure from angiography were obtained in 90% and 74%, respectively. Ipsilateral inferior petrosal sinus-intercavernous sinus-contralateral cavernous sinus catheterization was the major approach route of treatment. The factors associated with improved clinical outcome were transvenous approach, shunt closure, coil embolization, and sequencing the embolization (P < 0.001). CONCLUSIONS: Dangerous venous drainage tends to increase in bilateral CS-dAVF. Retrograde ipsilateral inferior petrosal sinus catheterization using coil embolization and sequencing the embolization are the major concerns for treatment.

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Seno Cavernoso/cirugía , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Senos Craneales/cirugía , Procedimientos Endovasculares , Anciano , Encéfalo/irrigación sanguínea , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento

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Background Magnetic resonance intracranial black blood vessel imaging (MR-IBBVI) is a new noninvasive method for evaluating intracranial vessel wall pathology. No previous studies have investigated the efficacy of MR-IBBVI to determine aneurysm size. We aimed to identify the precise diagnosis of MR-IBBVI for the detection and measurement of intracranial aneurysm compared with gold standard cerebral digital subtraction angiography (cDSA). Materials and Methods The retrospective study collected patients of precoiled or postcoiled intracranial aneurysm who were treated at our institute from January 2012 to June 2019 and who had MR-IBBVI, cDSA imaging, and/or three-dimensional time-of-flight sequence of magnetic resonance angiography. The sensitivity and specificity of aneurysm detection by MR-IBBVI and the accuracy of MR-IBBVI for measuring the aneurysm and vessel size were calculated. Results One hundred and twenty patients (61% female) with 132 aneurysms were included into this study. The mean aneurysm size was 5.3 mm (range: 2.2-22.6). Sensitivity and specificity of MR-IBBVI to detect a small aneurysm were 98.74 and 91.21%, respectively. No statistically significant results were observed between MR-IBBVI and DSA for aneurysm detection or any of the evaluated measurement parameters. Conclusion MR-IBBVI is an accurate and highly sensitive method to detect and evaluate the size of an intracranial aneurysm both before and after coiling.

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OBJECTIVE: The objective is to demonstrate change of cerebral perfusion and cerebrovascular reserve (CVR) in treating patients with cerebrovascular steno-occlusive disease stratified by change of cerebral perfusion and CVR. METHODS: Retrospective review patients with radiographic proven major cerebrovascular steno-occlusive disease whom underwent cerebral perfusion imaging with vasoactive stimuli stress test in Siriraj Hospital and Bangkok General Hospital during 2010-2018. Medical records were also reviewed. Radiographic findings, cerebral perfusion parameters and signal change during the stress test were reviewed and used to categorize into three groups. RESULTS: There were 40 patients sent to radiology department for the evaluation of CVR. One patient had airway problem during the procedure and was excluded. Remaining 39 patients were included in this study (32 males and 7 females, mean age of 54.55 years). In 42 sites involved, 28 (66%) were internal carotid artery, 14 (33%) were middle cerebral arteries. Laterality is left side in 20 cases, right side in 14 cases, and bilateral in 5 cases. Poor CVR response (increased cerebral blood flow <10%) was found in 9 patients (2 severe stenoses and 7 total occlusions). The mean follow-up time was 28.9 months. Eight cases (20.5%) underwent surgical treatment; surgical bypasses and endovascular interventions. Only one patient had subsequential ischemic symptom at immediate postoperative vascular bypass surgery. The remaining patients had no report of progressive or recurrent neurological deficit symptom. CONCLUSION: Poor CVR response is more often found in higher degree of steno-occlusion. Even inconclusive predicting incidence of recurrent ischemic stroke, CVR that reflects the capacity of neuro-autoregulation.

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Surgical management of basilar apex aneurysms remains one of the most challenging areas in neurovascular surgery. Technical demands of treating these aneurysms have inspired several generations of neurosurgeons to push the limitations of technical achievement. Advances in neuroanesthesia, cerebral protection paradigms, and critical care management have enhanced surgical outcomes of these lesions. Several approaches have been described to reach these lesions from anterolateral or lateral corridors. Each surgical approach has its own advantages and limitations and should be chosen for each patient according to the aneurysm's position, projection, parent arteries, and perforators. In this review, we will discuss pros and cons of the common approaches to these aneurysms with description of the important steps of each surgical procedure.

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BACKGROUND: Traumatic cerebrovascular injury (TCVI) is uncommon in traumatic brain injury (TBI). Although TCVI is a rare condition, this complication is serious. A missed or delayed diagnosis may lead to an unexpected life-threatening hemorrhagic event or persistent neurological deficit. The object of this study was to determine the prevalence and risk factors associated with TCVI. METHODS: The authors retrospectively reviewed medical records and neuroimaging studies of 5178 patients with TBI. The association of various factors was investigated using time-to-event statistical analysis. A TCVI which resulted in an occlusion, arteriovenous fistula, pseudoaneurysm or cerebral artery transection was defined as an event. RESULTS: Forty-two patients developed a TCVI after injuries with an overall prevalence of 0.8%. The risk factors for an intracranial arterial injury based on univariate analysis using the Cox proportional hazard regression were penetrating injury, severe head injury, orbitofacial injury, basilar skull fracture, subdural hematoma, and cerebral contusion. In multivariable analysis, the two variables that were independently associated with TCVI were basilar skull fracture (odds ratio [OR] 22.1, 95% confidence interval [CI] 11.5-42.2) followed by orbitofacial fracture (OR 13.6, 95% CI 6.8-27.3). CONCLUSIONS: Although TCVI is a rare complication of TBI, early investigation in high-risk patients may be necessary for early treatment before an unexpected fatal event occurs.

Asunto(s)

Lesiones Traumáticas del Encéfalo/epidemiología , Prevalencia , Adolescente , Adulto , Lesiones Traumáticas del Encéfalo/diagnóstico , Niño , Preescolar , Femenino , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo

RESUMEN

OBJECTIVE: Traumatic cerebrovascular injury (TCVI) is a rare and serious complication of traumatic brain injury (TBI). Various forms of TCVIs have been reported, including occlusions, arteriovenous fistulas, pseudoaneurysms, and transections. They can present at a variety of intervals after TBI and may manifest as sudden episodes, progressive symptoms, and even delayed fatal events. The purpose of this study was to analyze cases of TCVI identified at a single institution and further explore types and characteristics of these complications of TBI in order to improve recognition and treatment of these injuries. METHODS: The authors performed a retrospective review of cases of TCVI identified at their institution between 2013 and 2016. A total of 5178 patients presented with TBI during this time period, and 42 of these patients qualified for a diagnosis of TCVI and had adequate medical and imaging records for analysis. Data from their cases were analyzed, and 3 illustrative cases are presented in detail. RESULTS: The most common type of TCVI was arteriovenous fistula (86.4%), followed by pseudoaneurysm (11.9%), occlusion (2.4%), and transection (2.4%). The mortality rate of patients with TCVI was 7.1%. CONCLUSIONS: The authors describe the clinical characteristics of patients with TCVI and provide data from a series of 42 cases. It is important to recognize TCVI in order to facilitate early diagnosis and treatment.

Asunto(s)

Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Traumatismos Cerebrovasculares/diagnóstico por imagen , Adolescente , Adulto , Lesiones Traumáticas del Encéfalo/etiología , Traumatismos Cerebrovasculares/etiología , Resultado Fatal , Humanos , Masculino , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND AND PURPOSE: The aim of this study was to investigate the efficacy of thrombus density on noninvasive computed tomography (CT) neuroimaging for predicting thrombus pathology and patient outcome after mechanical thrombectomy in acute ischemic stroke. MATERIALS AND METHODS: This retrospective chart and imaging review included patients that were treated by mechanical thrombectomy at Siriraj Hospital according to the American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke from March 2010 to February 2015 study period. Preintervention noncontrast CT (NCCT), CT angiography (CTA), and/or contrast-enhanced CT (CECT) images were interpreted using CT densitometry. Pathology results were classified as white, red, or mixed thrombi. The result of treatment was evaluated by the modified Rankin Scale at 90 days after treatment. RESULTS: From 97 included patients - 97 NCCT images, 48 CTA images, 48 CECT images, and 54 pathologic results of cerebral thrombi were included in the final analysis. Mean clot Hounsfield unit values on NCCT, CTA, and CECT were significantly different between red and white thrombus (P = 0.001 on NCCT, P = 0.03 on CTA, and P = 0.001 on CECT), and between red and mixed thrombus (P = 0.043 on NCCT and P = 0.002 on CTA). However, no significant difference was observed between white thrombus and mixed thrombus (P = 0.09 on NCCT, P = 1.00 on CTA, and P = 0.054 on CECT). There was no significant correlation between type of cerebral thrombus or clot density and the result of treatment. CONCLUSION: Thrombus density on CT was found to be a significant predictor of thrombus pathology; however, no significant association was observed between thrombus type or clot density and patient outcome after mechanical thrombectomy.

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OBJECTIVE: Surgical site infection (SSI) following a neurosurgical operation is a complication that impacts morbidity, mortality, and economics. Currently, machine learning (ML) algorithms are used for outcome prediction in various neurosurgical aspects. The implementation of ML algorithms to learn from medical data may help in obtaining prognostic information on diseases, especially SSIs. The purpose of this study was to compare the performance of various ML models for predicting surgical infection after neurosurgical operations. METHODS: A retrospective cohort study was conducted on patients who had undergone neurosurgical operations at tertiary care hospitals between 2010 and 2017. Supervised ML algorithms, which included decision tree, naive Bayes with Laplace correction, k-nearest neighbors, and artificial neural networks, were trained and tested as binary classifiers (infection or no infection). To evaluate the ML models from the testing data set, their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as their accuracy, receiver operating characteristic curve, and area under the receiver operating characteristic curve (AUC) were analyzed. RESULTS: Data were available for 1471 patients in the study period. The SSI rate was 4.6%, and the type of SSI was superficial, deep, and organ/space in 1.2%, 0.8%, and 2.6% of cases, respectively. Using the backward stepwise method, the authors determined that the significant predictors of SSI in the multivariable Cox regression analysis were postoperative CSF leakage/subgaleal collection (HR 4.24, p < 0.001) and postoperative fever (HR 1.67, p = 0.04). Compared with other ML algorithms, the naive Bayes had the highest performance with sensitivity at 63%, specificity at 87%, PPV at 29%, NPV at 96%, and AUC at 76%. CONCLUSIONS: The naive Bayes algorithm is highlighted as an accurate ML method for predicting SSI after neurosurgical operations because of its reasonable accuracy. Thus, it can be used to effectively predict SSI in individual neurosurgical patients. Therefore, close monitoring and allocation of treatment strategies can be informed by ML predictions in general practice.

Asunto(s)

Aprendizaje Automático , Neurocirugia , Procedimientos Neuroquirúrgicos/efectos adversos , Infección de la Herida Quirúrgica/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurocirugia/métodos , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología

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The efficacy and safety of intrathecal (ITH) or intraventricular (IVT) colistin in addition to intravenous (IV) colistin for meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii (CRAB) is unclear. In this retrospective observational study of 40 patients with post-neurosurgical meningitis and ventriculitis due to CRAB, 33 patients without concomitant infection received appropriate dosage regimens of IV colistin. Of the 33 patients, 17 received additional ITH/IVT colistin and 16 received only IV colistin. The 14-day, 30-day and in-hospital mortality rates were nominally lower for patients who received ITH/IVT colistin adjunctive therapy versus patients who received only IV colistin (24% vs. 38%, 29% vs. 56% and 29% vs. 56%, respectively). The costs of treatment were significantly lower, the lengths of hospital and intensive care unit (ICU) stay were significantly shorter, and the number of ventilator days was significantly less among patients who received ITH/IVT colistin compared with patients who did not receive ITH/IVT colistin. The initial Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale (GCS) scores were associated with 30-day mortality with odds ratios (95% confidence intervals) of 1.21 (1.08-1.46) and 0.77 (0.44-0.85), respectively. Chemical meningitis from ITH/IVT colistin was mild and resolved spontaneously. Treatment of post-neurosurgical CRAB meningitis and ventriculitis with ITH/IVT colistin as an adjunct to IV colistin was associated with shorter lengths of hospital and ICU stay and a trend to lower mortality, especially among severely ill patients.

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Infecciones por Acinetobacter/tratamiento farmacológico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Ventriculitis Cerebral/tratamiento farmacológico , Colistina/administración & dosificación , Colistina/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Administración Intravenosa , Adulto , Antibacterianos/economía , Barrera Hematoencefálica , Carbapenémicos/farmacología , Ventriculitis Cerebral/microbiología , Ventriculitis Cerebral/mortalidad , Colistina/economía , Femenino , Humanos , Inyecciones Intraventriculares , Inyecciones Espinales , Masculino , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/mortalidad

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Cavernous carotid aneurysms (CCAs) are uncommon pathologic entities. Extradural place and the skull base location make this type of an aneurysm different in clinical features and treatment techniques. Direct aneurysm clipping is technically difficult and results in a significant postoperative neurological deficit. Therefore, several techniques of indirect surgical treatment were developed with different surgical outcomes, such as proximal occlusion of internal carotid artery (ICA) or trapping with or without bypass (superficial temporal artery-middle cerebral artery bypass or high-flow bypass). High-flow bypass with proximal ICA occlusion seems to be the most appropriate surgical treatment for CCA because of the high rate of symptom improvement, aneurysm thrombosis, and minimal postoperative complications. However, in cases of CCA presented with direct carotid-cavernous fistula, the appropriate surgical treatment is high-flow bypass with aneurysm trapping, which the fistula can be obliterated immediately after surgery.

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BACKGROUND: We would like to know the exact rate of ischemic event and the risk factors associated with embolic stroke by treatment of atherosclerotic cerebral aneurysm with a new technique. METHODS: This is a retrospective cohort study in patients diagnosed as unruptured atherosclerotic cerebral aneurysm who underwent microsurgical clipping between January 2012 and August 2014. All intraoperative video recordings were reviewed and chosen in patients who were identified as atherosclerotic lesion on the dome, neck, or parent artery of the aneurysm. The demographic, radiographic, operative, and postoperative data were collected. The primary end point was the incidence of cerebral infarction and the neurologic outcomes using the discharge modified Rankin Scale (mRS) score at postoperation time. A statistical analysis of the factors associated with embolic stroke was done by Fisher exact and Wilcoxon rank-sum tests. The individual surgical technique was demonstrated as an illustration for use as a guide. RESULTS: Among 103 atherosclerotic cerebral aneurysms, only 3 patients (2.9%) were associated with postoperative cerebral infarction and 1 of them had permanent neurologic deficit. A good mRS score (0-2) was found in 99% of patients and only 1% had a fair mRS score (3-4). A factor associated with ischemic outcome was duration of operation (P = .046). The differences in the atherosclerotic location showed no statistical significance. CONCLUSIONS: We found a very low incidence of embolic infarction after clipping of an atherosclerotic cerebral aneurysm with our new technique. Only duration of the operation time was a dependent risk factor for embolic infarction.

Asunto(s)

Aneurisma Intracraneal/cirugía , Arteriosclerosis Intracraneal/cirugía , Instrumentos Quirúrgicos , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Imagenología Tridimensional , Aneurisma Intracraneal/complicaciones , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/etiología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Examen Neurológico , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To identify the significant factors predicting afavorable outcome and to study clinical characteristics and identify the factors predicted by intraventricular rupture of brain abscess (IVROBA). MATERIAL AND METHOD: In the retrospective study, the computer-based medical records of patients of a tertiary care hospital between 1999 and 2013 were reviewed. Univariate and multivariate analyses were used to determine the significant factors predicting the outcomes and IVROBA. RESULTS: One hundred fourteen patients with brain abscesses were enrolled. The predictivefactor of a favorable outcome was Glasgow Coma Scale (GCS) score 13 to 15 (OR 14.64; 95% CI 2.70-79.34; p = 0.02). Conversely, the factors associated with an unfavorable outcome were fungal brain abscess (OR 40.81; 95% CI 3.57-466.49; p = 0.003) and IVROBA (OR 5.50; 95% CI 1.34-22.49; p = 0.017). Moreover greater distance of the brain abscess from the ventricle decreased the IVROBA (OR 0.62; 95% CI 0.45-0.87; p = 0.005). Abscesses with intraventricular rupture that were at less than 7 mm of a ventricle (p < 0.000) were likely to IVROBA. CONCLUSION: The outcome of a brain abscess depends on good clinical status, pathogens, and fatal complication of lVROBA. If poor prognostic factors exist, then better surgical option can be selected.

Asunto(s)

Absceso Encefálico/patología , Anciano , Absceso Encefálico/microbiología , Absceso Encefálico/terapia , Ventrículos Cerebrales/microbiología , Ventrículos Cerebrales/patología , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Rotura Espontánea/microbiología , Rotura Espontánea/patología , Rotura Espontánea/terapia , Resultado del Tratamiento

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OBJECTIVE: To determine the recurrence and malignancy free survival time and associated factors with recurrence and malignant transformation of patients with low-grade gliomas after primary surgical resection. MATERIAL AND METHOD: The present study was retrospective. Patients who underwent surgery and were diagnosed with low-grade gliomas between January 2000 and October 2009 were recruited. Time to recurrence and malignant transformation were analyzed using Kaplan-Meier method and multivariate Cox proportional hazard regression models. RESULTS: Seventy-seven patients underwent surgery for low-grade glioma. The pathological reports were diffuse astrocytoma in 55 patients (71%), oligodendroglioma in 19 patients (25%), and oligoastrocytoma in three patients (40%). The types of tumor resection were biopsy in 39 patients (50%), subtotal resection 34 patients (44%), and total resection in four patients (5%). The overall mean time to follow-up was 40 months, the median recurrence and malignant transformation times were 14 and 24 months. The 5-year recurrence-free and malignant-free survival rate was 50% and 68%. Factors associated with tumor recurrence were age, sex, presenting symptoms, preoperative Karnofsky performance status (KPS) score, tumor volume, and contrast enhancement. None of these factors showed statistically significant association with malignant transformation. CONCLUSION: One fourth of the patients had tumor recurrence and malignant transformation in a short period of time. Delayed recurrence and malignant transformation after primary resection are associated with several factors. The type of surgery especially total-subtotal resection might favor prognosis.

Asunto(s)

Neoplasias Encefálicas/patología , Glioma/patología , Adolescente , Adulto , Neoplasias Encefálicas/cirugía , Transformación Celular Neoplásica , Medios de Contraste , Femenino , Glioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia