• Ryosuke Matsuda, Ryosuke Maeoka, Noriaki Tokuda, Tsutomu Nakazawa, Takayuki Morimoto, Masashi Kotsugi, Yasuhiro Takeshima, Kentaro Tamura, Shuichi Yamada, Fumihiko Nishimura, Ichiro Nakagawa, Young-Soo Park, and Hiroyuki Nakase.
• Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan. Electronic address: rmatsuda@naramed-u.ac.jp.
• World Neurosurg. 2023 Mar 1; 171: e707e713e707-e713.

ObjectiveTo evaluate the safety profile of bis-chloroethyl-nitrosourea (BCNU) wafer implantation after malignant glioma resection with or without ventricular opening (VO).MethodsThis single-center retrospective study included 66 consecutive patients with BCNU wafer implantation after malignant glioma resection between March 2013 and August 2021. The patients were categorized into 2 groups based on whether VO occurred during the malignant glioma resection. Fifty-eight patients had glioblastoma, and 8 had anaplastic astrocytoma or oligodendroglioma. Forty-eight patients underwent an initial treatment, and 18 underwent recurrent surgeries. Infection, hydrocephalus, subcutaneous fluid collection, chronic subdural hematoma, early seizure after surgery within 1 month, symptomatic edema surrounding the resected cavity, cyst formation, and postoperative hemorrhage were defined as adverse events (AEs).ResultsThirty-three patients underwent resection with VO, and 33 without. The median survival time was 28 months in the initial treatment group and 11.5 months in the recurrent treatment group. The with and without VO groups had similar median survival times. Postoperative AEs occurred in 7/33 patients (21.2%) with VO and 10/33 (30.3%) without VO, with no difference between them (P = 0.574).ConclusionsThis study showed that VO during surgery with BCNU wafer implantation might not influence the occurrence of postoperative AEs. If VO happens, BCNU wafer implantation can be performed safely with accurate closing of the ventricle.Copyright © 2022 Elsevier Inc. All rights reserved.

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