The predominant factor of undergoing glioma surgery is not one of cure, since this cannot be achieved. The main purpose is to establish a definitive diagnosis and to achieve cytoreduction, in order to stabilise and hopefully improve the neurological deficits and also to enable other treatment options (such as radiotherapy and/or chemotherapy) to be more effective, as they have less residual tumour bulk to deal with.
However, no surgery is without risks, and this is very much the case with neurosurgery, especially when dealing with gliomas that diffusely infiltrate the surrounding brain tissue, destroying specific functions as they grow and causing irreversible damage to the brain. Wound healing impairment, surgical site infections (SSI) and post-operative morbidity are serious problems in neurosurgery, associated with prolonged inpatient stays, increased costs and patient discomfort. Thirty-day readmission rates have become a proxy for quality of care, contributing significantly to high health-care costs. Helping to reduce surgical complications and improve patient’s quality of life is pivotal to neurosurgical nursing.
This chapter will therefore explore some of the more common surgical complications associated with glioma surgery (both pre- and post-operatively) and help equip the novice nurse with practical information about how to not only identify surgical problems early but also how to treat them effectively and how to help the patients and their carers cope with long-term side effects and adapt to a new way of living with a life-limiting disease.
Glioma surgery Neurosurgery Wound infections Surgical site infections Brain tumours Post-operative complications
This is a preview of subscription content, log in to check access.
Hong B, Winkel A, Ertl P, et al. Bacterial colonisation of suture material after routine neurosurgical procedures: relevance for wound infection. Acta Neurochir. 2018;160:497–503.CrossRefGoogle Scholar
Skally M, Finn C, O'Brien D, et al. Invasive MRSA infections in neurosurgical patients-a decade of progress. Br J Neurosurg. 2017;31(3):374–8.CrossRefGoogle Scholar
Cho J, Harrop J, Veznaedaroglu E, et al. Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution. Neurosurgery. 2003;52:832–40. discussion 840–1CrossRefGoogle Scholar
Broekman MLD, Van Beijnum J, Peul WC, et al. Neurosurgery and shaving. What is the evidence? A review. J Neurosurg. 2011;115(4):670–8.CrossRefGoogle Scholar
Nandapalan V, Watson ID, Swift AC. Beta-2-transferrin and cerebrospinal fluid rhinorrhea. Clin Otolaryngol. 1996;21(3):259–64.CrossRefGoogle Scholar
Hickey J. Overview of neuroanatomy and physiology. In: The clinical practice of neurological and neurosurgical nursing. 7th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2013. Chapter 5, 14 and 23.Google Scholar
Lepanluoma M, Takala R, Kotkansalo A, et al. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery. Scand J Surg. 2014;103(1):66–72.CrossRefGoogle Scholar
Krishnan KG, Muller A, Hong B, et al. Complex wound-healing problems in neurosurgical patients: Risk factors, grading and treatment strategy. Acta Neurochir. 2012;154(3):541–53.CrossRefGoogle Scholar
Sonneville R, Ruimy R, Benzonana N, et al. An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017;23(9):614–20.CrossRefGoogle Scholar
Merkler AE, Ch'ang J, Parker WE, et al. The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg. 2017;98:654–8.CrossRefGoogle Scholar
Mantia C, Uhlmann EJ, Puligandla M, et al. Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood. 2017;129(25):3379–85.PubMedGoogle Scholar
Cote DJ, Dubois HM, Karhade AV, et al. Venous thromboembolism in patients undergoing craniotomy for brain tumors: a U.S. nationwide analysis. Semin Thromb Hemost. 2016;42(8):870–6.CrossRefGoogle Scholar
Wade R, Paton F, Woolacott N. Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients. J Adv Nurs. 2017;73(2):336–48.CrossRefGoogle Scholar
Bhattacharya V, Stansby G, Kesteven P. Prevention and management of venous thromboembolism. 1st ed. London: Imperial College Press; 2015. Chapters 4,7 and 10CrossRefGoogle Scholar
Duffau H. Mapping the connectome in awake surgery for gliomas: an update. J Neurosurg Sci. 2017;61(6):612–30.PubMedGoogle Scholar
Kirk EA, Howard VC, Scott CA. Description of posterior fossa syndrome in children after posterior fossa brain tumor surgery. J Pediat Oncol Nurs. 1995;12(4):181–7.CrossRefGoogle Scholar
Bannur U, Rajshekhar V. Post operative supplementary motor area syndrome: clinical features and outcomes. Br J Neurosurg. 2000;14(3):204–10.CrossRefGoogle Scholar
Teasell R, Bayona N, Salter K, et al. Progress in clinical neurosciences: Stroke recovery and rehabilitation. Can J Neurol Sci. 2006;33(4):357–64.CrossRefGoogle Scholar
Senders JT, Muskens IS, Schnoor R, et al. Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results. Acta Neurochir. 2017;159(1):151–67.CrossRefGoogle Scholar
Ma R, Watts C. Selective 5-aminolevulinic acid-induced protoporphyrin IX fluorescence in Gliomas. Acta Neurochir. 2016;158(10):1935–41.CrossRefGoogle Scholar
Roux A, Caire F, Guyotat J, et al. Carmustine wafer implantation for high-grade gliomas: evidence-based safety efficacy and practical recommendations from the Neuro-oncology Club of the French Society of Neurosurgery. Neurochirurgie. 2017;63(6):433–43.CrossRefGoogle Scholar
Sage W, Guilfoyle M, Luney C, et al. Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit. J Neurooncol. 2018;136:273–80.CrossRefGoogle Scholar