SURG-06. OUTCOMES OF SECOND SURGERY FOR RECURRENT GLIOBLASTOMA MULTIFORME: A RETROSPECTIVE CASE CONTROL STUDY

BACKGROUND: Despite multimodal therapies extending patient sur- vival, Glioblastoma multiforme (GBM) recurrence is all but a certainty. To date, there have only been a few single-center studies looking at reopera- tions. Our study aimed to assess GBM reoperation trends nationally, with emphasis on outcomes. METHODS: The linked Surveillance, Epidemiol- ogy, and End Results (SEER) – Medicare database was searched to iden-tify patients 66 years and older with GBM from 1997-2010. The primary outcome was survival after diagnosis. Kaplan-Meier curves and multivariate analysis with the proportional hazard ratios were used. RESULTS: A total of 3,784 patients with recurrent GBM were identified. At the time of initial diagnosis, 341 patients (9%) underwent a biopsy as the first surgery, and 3,443 patients (91%) received a gross total resection. Reoperation - whether after an initial biopsy or resection - increased survival in patients, with a median survival of 5 months in the group that did not receive reoperation vs. 11 months in the group that did (p<.0001). Reoperated patients that under- went biopsy as the initial surgery had a median survival of 3 months without reoperation and 8 months with (P=<0.0001). In contrast, patients that underwent resection at the initial surgery had a median survival of 5 months without reoperation and 13 months with (P= <0.0001). Within the reop- erated cohort, extent of the initial surgery differentially affected survival, with gross total resection appearing to improve median survival (HR 0.794, 0.731-0.962) compared to partial resection (1.033) and all other less com-plete resections (1.072) correlated. No statistically significant difference in survival was observed across geographic regions or academic versus private hospitals. CONCLUSION: Though definitive conclusions cannot be made given the lack of granularity, our study does support gross total resection as the initial treatment of choice for GBM, followed by reoperation, if toler- ated, at the time of recurrence. AIM: There is variable evidence on the effect of surgery for recurrent glioblastoma multiforme (GBM) on overall survival. Data on this has been marred with patient cohorts that were not exclusively with GBM and been staggered across three decades. There has also not been a case control approach to looking at this data. METHOD: Retrospective data on all patients with recurrent GBM in two tertiary hospitals from Jan 2010 – Dec 2014 was collected. At each centre, non-resected patients were matched with resected patients on extent of resection and age, and a case-control matched study was conducted. Survival was assessed as from initial diagnosis (OS 1 ) and from date of recurrence (OS 2 ). Functional outcomes of patients post resection was also analysed. RESULTS: There were 60 patients in each cohort with a median age of diagnosis was 56.8 years. The most common location for tumour was the temporal location (n=49 at first resection, n=46 at second resection). Median progression free survival was 8.35m (95% CI: 7.2 - 9.6m). Median OS 1 : 14.17m (95% CI: 11.5 - 15.72m) versus 21.54m (95% CI 18 - 24.67m). There was a difference in OS 2 of 4.9m (4.6 vs 9.5m). Surgery at recurrence correlated with a better OS 2 out- come (p=<0.001, HR 0.523, 95% CI 0.378 - 0.724). Other factors such as chemo at recurrence had a positive impact on OS 2 (HR 0.468, p=0.0284, 95% CI 0.237-0.923). Frontal lobe recurrence didn’t have an impact on OS 2 (HR 0.815, p=0.4094, 95% CI 0.501-1.325). Post surgery; 78% didn’t require rehabilitation and 61% were independent with their mobility. CON-CLUSION: Second surgery for recurrent GBM is beneficial with a survival advantage. There is also a survival advantage in having chemotherapy (with or without surgery) at recurrence. Outcomes post surgery was also promis- ing. More studies are required in the era of improved surgical techniques and new anti-neoplastic therapies. BACKGROUND: Endoscope is now increasingly being used to manage orbital lesions. The aim of the paper is to report our experience of managing 7 cases of different orbital lesions by endonasal pure endoscopic approach. MATERIAL AND METHOD: The study was performed by retrospective review of the medical records of the patients of orbital lesions operated in our department. RESULTS: Seven patients (male 5, female 2) presented with unilateral progressive proptosis (n=7), restriction of eye movement and diplopia (n=5), visual deterioration (n=1) and unilateral blindness (n=1). MRI was suggestive of intraconal (n=6) and intraconal and extraconal (n=1) lesions. The lesions were excised by pure endoscopic endonasal endoscopic approach in all the cases. Histology was suggestive of hemangioma (n=3), solitary fibrous tumor (n=1), inflammatory pseudotumor (n=1), orbital lym- phoid tumor (n=1), and epidermoid (n=1). The extent of excision was total (n=6) and subtotal (n=1). Post-operatively propotosis resolved and symp- toms improved in all the cases. No complication was noted in 6 cases and remaining one had visual deterioration and transient ophthalmoparesis fol- lowing surgery. CONCLUSIONS: Endoscopic approaches to orbital lesions are minimally invasive and bear excellent outcome. the surgeons’ perception. RESULTS: Two-hundred twenty-four (n=224) awake surgeries were performed in the period from October 2009 till September 2015. In the “Awake-Awake-Awake” group (n=78) less opiates, less vasoactive and antihypertensive drugs were used in comparison to the “Sleep-Awake-Sleep” group (n=146). In addition, compliance was much higher rated in the “awake-awake-awake” group. CONCLUSIONS: Dexmedetomidine provides excellent setting for fully awake surgeries. Our experience shows that using dexmedetomidine as sole anaesthetic drug during awake craniotomies sedates moderately, acts anxiolytic and after ceasing infusion enables quick and reliable clinical neurological assessment of patients.