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Topic: Neuroimmunology and Cancer

The influence of postoperative infection in

survival of patients with high‑grade gliomas

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George A. Alexiou , Amalia Kallinteri , Euaggelos Michos , Panagiota Zagorianakou , Efthalia Priavali ,
1
Dimitrios Pachatouridis , Stamatina Levidiotou , Spyridon Voulgaris 1
2
1 Department of Neurosurgery, Medical School, University of Ioannina, 45110 Ioannina, Greece.
2 Department of Microbiology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
ABSTRA CT
High‑grade gliomas are the most common type of brain tumors. Of these, glioblastoma account for 60‑70% and despite treatment
carries a dismal prognosis. Postoperative surgical site infection has been associated with prolonged survival. Herewith, we present
a case of glioblastoma and a case of anaplastic oligoastrocytoma that developed postoperative infection of the surgical site and had
prolonged survival. A thorough literature review is also presented.
Key words: Glioblastoma, high‑grade glioma, infection, survival

INTRODUCTION enhanced after gadolinium administration, The
Karnofsky performance scale (KPS) score was 100.
High-grade gliomas are the most common type of The patient underwent a left frontal craniotomy
primary brain tumors and carry a dismal prognosis. with radical resection of the lesion. Histological
[1]
Glioblastoma is by far the most common type occurring examination revealed the presence of a glioblastoma.
in adults. This devastating disease is usually incurable The postoperative KPS at the time of discharge was 100.
and despite aggressive treatment the median survival The patient received concomitant temozolomide (TMZ)
time remains in the range of 15 months. Median with radiotherapy (60 Gy) followed by adjuvant TMZ.
[1]
survival for anaplastic tumors is usually 2-3 years Eleven months later the patient had a generalized
with anaplastic oligodendroglioma having a better seizure. Follow-up MRI revealed a lesion suspicious
survival. There have been reports that patients of tumor recurrence. Brain single-photon emission
[2]
with postoperative infection of the craniotomy site computed tomography (SPECT) with 99m Tc-tetrofosmin
experienced long term survival. [3,4] Herewith, we report demonstrated increased tracer uptake suggesting tumor
on two cases of high-grade gliomas with confirmed recurrence. The patient was re-operated, and carmustine
postoperative infection and prolong survival. wafers were placed around the resection cavity. The
postoperative period was uneventful, and the patient
CASE REPORT was discharged home on the 7th postoperative day.
One week later the patient was hospitalized because
Case 1 of discharge from the surgical wound. Wound cultures
A 48-year-old woman underwent a brain magnetic were obtained. Identification and antimicrobial
resonance imaging (MRI) because of persisted susceptibility of the microorganisms were performed by
headache and dizziness. A left frontal lesion the automatized VITEK 2 System (BioMerieux, France).
(4.2 cm × 3.7 cm × 5 cm) with prominent peri-focal The results showed the presence of Staphylococcus
edema and mass effect was revealed. The lesion haemolyticus (coagulase-negative Staphylococcus,
CoNS) resistant to penicillin, oxacillin, levofloxacin,
Access this article online moxifloxacin and gentamycin. The patient received
Quick Response Code: proper antibiotic treatment, and the infection was
Website: resolved. The patient remained free of disease for
www.nnjournal.net
27 months when recurrence was noted on follow-up
DOI: MRI. Anti-VEGF treatment was administered; however,
10.4103/2347-8659.149418 she died 3 months later. Her overall survival was
42 months.

Corresponding Author: Dr. George A. Alexiou, Department of Neurosurgery, Medical School, University of Ioannina, 45110
Ioannina, Greece. E‑mail: alexiougrg@yahoo.gr

18 Neuroimmunol Neuroinflammation | Volume 2 | Issue 1 | January 15, 2015