Periventricular gliomas: Evaluation of the risks associated with ventricular opening in two cohorts—one prospective with TachoSil® for ventricular sealing and the other without it retrospective

Abstract

Introduction: Historically, ventricular opening (VO) has been associated with a greater risk of postoperative complications and a risk of leptomeningeal spread (LMS) in periventricular gliomas especially high grade gliomas. There are no specific products on the market for ventricular sealing with registered studies. TachoSil® is widely used for supportive sealing of the dura mater. We wanted to assess the effectiveness and safety of TachoSil® as a ventricular sealant for periventricular gliomas surgery with VO. Methods: A single-center, analytical, and observational study was conducted. Two cohorts of patients with gliomas and VO were compared. A prospective cohort treated with TachoSil® (2020–2024) and a retrospective control cohort without TachoSil® (2017–2023). We recorded epidemiological, clinical, radiological, and surgical variables and the percentage of complications attributable to the VO: CSF leak, pseudomeningocele, infection, hydrocephalus, or leptomeningeal spread (LMS). Results: We included 68 patients: the prospective cohort treated with TachoSil® consisted of 37 patients and the control group of 31. The demographic, clinical, and radiologic characteristics of two cohorts were statistically homogeneous. Ventricular sealing with TachoSil® had wider resections (1.54cm3 ± SD 1.92 residual tumor volume vs. 3.71 cm3 ± SD 5.64, p = 0.032) and fewer postoperative complications related to VO (2 vs. 9 patients, p = 0.008). Conclusion: This study demonstrates that the use of TachoSil® for sealing glioma patients with VO is safe and effective, reducing complications related to VO, increase the degree of resection and reduces readmissions and reinterventions resulting from complications arising from VO. A randomized clinical trial should be conducted.