Clinical Effect of Ventricular Entry During Resection of Isocitrate Dehydrogenase-Wildtype Glioblastoma: A Multi-Institutional Analysis.

Abstract

Glioblastomas contacting the subventricular zone (SVZ) are associated with poor prognosis, and the impact of ventricular entry (VE) during resection remains controversial. Since glioblastomas with SVZ involvement often require VE, both SVZ involvement and VE are confounding factors. This study aimed to evaluate the effect of VE during glioblastoma resection by comparing patients with and without SVZ involvement. This multi-institutional retrospective study reviewed newly diagnosed isocitrate dehydrogenase-wildtype glioblastoma who underwent resection. The focus was on VE, complications, and recurrence patterns based on SVZ status. A total of 418 patients were included with 278 (66.5%) undergoing VE and 140 (33.5%) without. Patients with VE had significantly shorter overall survival (OS) than those without VE (18.6 vs. 25.6 months, P = 0.008). VE was more common in patients with SVZ tumors (94.2%) compared to non-SVZ tumors (26.3%, P < 0.0001). Notably, 44 patients with non-SVZ tumors experienced VE, whereas 15 patients with SVZ tumors did not. Regardless of SVZ status, VE did not affect the rates of complications, such as symptomatic subdural effusion, hydrocephalus, infection, or nonlocal recurrence. OS was similar for each group: for SVZ tumors, OS was 17.7 months with VE versus 19.9 months without VE (P = 0.34), and for non-SVZ tumors, OS was 30.8 months with VE versus 25.6 months without VE (P = 0.63). VE during glioblastoma resection does not impact complications or nonlocal recurrence. Surgeons may safely perform VE during resection of both SVZ and non-SVZ glioblastomas without adverse effects.