Navigating Post-Operative Neurological Complications in Brain Tumor Surgery

Although brain tumor surgery may be a critical component of treatment, it carries the potential for post-operative neurological complications that can significantly impact patient outcomes and quality of life. For oncology clinicians involved in the care of these patients, a comprehensive understanding of these potential complications and the strategies to mitigate and manage them are paramount.

Jennifer Moliterno, MD, FAANS, chief of Neurosurgical Oncology; clinical director of the Chênevert Family Brain Tumor Center; director of the Susan Beris, MD, Neurosurgical Oncology Program; surgical director of the Facial Pain and Spasm Program; and director of Neurosurgical Oncology Fellowship, Neurosurgical Oncology at Yale School of Medicine, spoke with CancerNetwork® about common neurological deficits that can arise in the immediate and longer term following brain tumor resection.

These complications may include motor weakness, sensory disturbances, bleeding, and infection. She elucidated the underlying mechanisms contributing to these complications, such as the location and behavior of the tumor.

Transcript:

The honest answer is [that preventing and managing complications] is very unique to each patient. As I always say to patients, there are standard risks of surgery, and so bleeding and infection are standard risks of any type of surgery, in general, and certainly with brain tumor surgery. What I will then tell patients is how their risk of surgery is tailored, and that a lot of times, it depends on the location of the tumor, how infiltrative the tumor is, the behavior of the tumor, and whether or not that tumor involves critical neurovascular structures, such as arteries. [With] bigger arteries, I am very used to working around and protecting them. Sometimes, even with my expertise and experience, the smaller arteries can get a little trickier, because they can be embedded in the tumor. They can supply the tumor, but also supply the brain, which can lead to post-operative issues such as weakness or a new neurological deficit.

Recurrent surgery is a different consideration in and of itself. Sometimes, patients will have multiple surgeries for progression or recurrence of disease. Each time we operate, the risk can be a bit higher for potential issues or complications. I always say it’s not so much having to relate to the surgery itself; the brain is different. The person’s brain has been through more: the radiation effects, the growth of the tumor, and the effects of the brain being sick for so long due to the tumor. [Regarding] those things, even I have found surgeries can go perfectly well from a technical standpoint, but we can still encounter issues post-operatively. That could be a little bit hard for someone’s brain to recover [from] the more they are in treatment. That usually reflects being on treatment for longer.