NEUROSURGICAL OUTCOMES IN A MODERN SERIES OF 400 CRANIOTOMIES FOR TREATMENT OF PARENCHYMAL TUMORS

OBJECTIVE: The goals were to critically review all complications resul ting within 30 days after craniotomies performed for excision of intra -axial brain tumors relative to factors likely to affect complication rates and to assess the value of these data in predicting the risk of surgical morbidity, particularly for surgery in eloquent brain regions . METHODS: Neurosurgical outcomes were studied for 327 patients who un derwent 400 craniotomies for removal of intra-axial parenchymal brain neoplasms in a 21-month period. Tumors removed included gliomas (206 t umors) and metastases (194 tumors) located both supratentorially (358 tumors) and infratentorially (42 tumors). RESULTS: The major complicat ion incidence was 13%, and the operative mortality rate was 1.7%. The overall morbidity rate was 32%, but more types of complications were c onsidered than in previous studies. The major neurological morbidity r ate was 8.5%. Based on pre-versus postoperative (at 4 wk) Karnofsky Pe rformance Scale scores, 9% of patients deteriorated neurologically, 32 % improved, and 58% showed no change. The median postoperative hospita l stay was 5 days. Tumors were defined as Grade I, II, or III based on their location relative to brain function, and this tumor functional grade was the most important variable affecting the incidence of any n eurological deficit. Patients with tumors in eloquent (Grade III) or n ear-eloquent (Grade II) brain areas incurred more neurological deficit s than did patients with tumors in noneloquent areas (Grade I). Neithe r repeat surgery for recurrent disease nor extent of surgical resectio n affected outcome significantly. Although most tumors in this study, including those in eloquent regions, were removed by gross total resec tion, this did not lead to more major neurological deficits. Regional complications (at the surgical sites) and systemic complications (medi cal) were more prevalent among older patients (age >60 yr) with lower preoperative Karnofsky Performance Scale scores (550) and posterior fo ssa masses. We showed how our data can be used to predict the total ri sk of surgical morbidity for a given patient, to facilitate patient co unseling and surgical decision-making. CONCLUSION: The finding that gr oss total resections could be performed in eloquent brain regions with an acceptable level of neurological impairment suggested that the mer e presence of a tumor in eloquent brain does not automatically contrai ndicate surgery. Our results have practical risk-predictive value, and they should aid in the construction of subsequent outcome studies, be cause we have identified the key areas to monitor.