To date, there is no standard treatment for recurrent glioblastoma.
Optimal management of recurrent high grade glioma continues to be a controversial topic. Current indications for reoperation include new focal neurological deficits, tumor mass effect resulting in signs and symptoms of increased intracranial pressure, increased seizure frequency, and radiographic evidence of tumor progression with or without accompanying changes in clinical status. Existing evidence indicates that age should not be an absolute contraindication to reoperation. A time interval of at least 6 months between operations and favorable performance status (KPS score >70) are predictors of improved survival after reoperation. Extent of resection (EOR) at reoperation appears to be an important determinant of improved survival, even in patients with subtotal resection (STR) at the time of initial operation. Although fraught with patient selection bias, mounting evidence suggests a survival benefit in patients receiving gross total resection (GTR) at recurrence compared with a lesser degree of resection. Additional reoperations beyond the first reoperation may add to overall survival and should be considered in patients with a favorable KPS score at the time of recurrence, regardless of symptomatology
Using the Get With The Guidelines Stroke registry, Prabhakaran et al., analyzed patients with a discharge diagnosis of SAH between April 2003 and March 2012 and assessed the association of annual SAH case volume with in-hospital mortality by using multivariable logistic regressionadjusting for relevant patient, hospital, and geographic characteristics.
Among 31,973 patients with SAH from 685 hospitals, the median annual case volume per hospital was 8.5 (25th-75th percentile, 6.7-12.9) patients. Mean in-hospital mortality was 25.7%, but was lower with increasing annual SAH volume: 29.5% in quartile 1 (range, 4-6.6), 27.0% in quartile 2 (range, 6.7-8.5), 24.1% in quartile 3 (range, 8.5-12.7), and 22.1% in quartile 4 (range, 12.9-94.5). Adjusting for patient and hospital characteristics, hospital SAH volume was independently associated with in-hospital mortality (adjusted odds ratio 0.79 for quartile 4 vs 1, 95% confidence interval, 0.67-0.92). The quartile of SAH volume also was associated with length of stay but not with discharge home or independent ambulatory status.
In a large nationwide registry, they observed that patients treated at hospitals with higher volumes of SAH patients have lower in-hospital mortality, independent of patient and hospital characteristics suggesting that experienced centers may provide more optimized care for SAH patients. 5)
doi: 10.1227/NEU.0000000000000475. PubMed PMID: 24979097.
Self-Assessment in Neurological Surgery (SANS) is a completely on-line educational tool. The teaching materials used in SANS consist of text, pictures, video clips and links to relevant Internet sites. Physicians participate in the learning process by answering questions in specific topic areas, reviewing their answers, and reading question critiques. The material is designed to be a self-instructional and self-assessment tool.
To apply for Continuing medical education (CME), users will need to complete SANS and fill out the CME survey. Partial CME credit will not be made available for incomplete participation in SANS.
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Tarantino R, Donnarumma P, Nigro L, Rullo M, Santoro A, Delfini R. Surgery of
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Phillips JL, Chalouhi N, Jabbour P, Starke RM, Bovenzi CD, Rosenwasser RH,
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873 patients. Neurosurgery. 2014 Nov;75(5):560-7. doi:
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Nelson KS, Brearley AM, Haines SJ. Evidence-based assessment of
well-established interventions: the parachute and the epidural hematoma.
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Paúl L, Casasco A, Kusak ME, MartÃnez N, Rey G, MartÃnez R. Results for a
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angiographic features on the obliteration rate. Neurosurgery. 2014
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Iwata T, Mori T, Miyazaki Y, Tanno Y, Kasakura S, Aoyagi Y. Global oxygen
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Rosenthal G, Ng I, Moscovici S, Lee KK, Lay T, Martin C, Manley GT.
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experience. Neurosurgery. 2014 Nov;75(5):523-9. doi:
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