The Impact of Lateral Ventricular Opening in the Resection of Newly Diagnosed High-Grade Gliomas: A Single Center Experience

Simple Summary This retrospective study investigates the validity of lateral ventricle opening during high-grade glioma (HGG) surgery, contributing to the literature by addressing its relationship with postoperative complications in a large cohort of newly diagnosed patients with HGG. The approach of dividing patients into groups with and without lateral ventricle opening enhances the study's internal validity, allowing for a direct comparison between the two conditions. The analysis of complications, including subependymal dissemination and multifocal progression, contributes to understanding associated side effects. Furthermore, the conclusion that lateral ventricle opening does not significantly increase the risks of dissemination, hydrocephalus or cerebrospinal fluid leakage suggests practical implications for surgery.Abstract Given the importance of maximizing resection for prognosis in patients with HGG and the potential risks associated with ventricle opening, this study aimed to assess the actual increase in post-surgical complications related to lateral ventricle opening and its influence on OS and PFS. A retrospective study was conducted on newly diagnosed HGG, dividing the patients into two groups according to whether the lateral ventricle was opened (69 patients) or not opened (311 patients). PFS, OS, subependymal dissemination, distant parenchymal recurrences, the development of hydrocephalus and CSF leak were considered outcome measures. A cohort of 380 patients (154 females (40.5%) and 226 males (59.5%)) was involved in the study (median age 61 years). The PFS averaged 10.9 months (+/- 13.3 SD), and OS averaged 16.6 months (+/- 16.3 SD). Among complications, subependymal dissemination was registered in 15 cases (3.9%), multifocal and multicentric progression in 56 cases (14.7%), leptomeningeal dissemination in 12 (3.2%) and hydrocephalus in 8 (2.1%). These occurrences could not be clearly justified by ventricular opening. The act of opening the lateral ventricles itself does not carry an elevated risk of dissemination, hydrocephalus or cerebrospinal fluid (CSF) leak. Therefore, if necessary, it should be pursued to achieve radical removal of the disease.