[Treatment of recurrent gliomas]

In operation for gliomas, it is our principle to remove extensively by sucker dissection technique. But, in many cases, we cannot achieve total removal because of invasion of tumor cells into the deep or vital structure. Postoperatively we apply irradiation, chemotherapy and immunotherapy in every cases. Even after multimodality treatment, recurrence may be inevitable. In order to check the recurrence as early as possible, we took follow-up CT scan regularly. When the recurrence appeared on CT scan, we actively performed reoperation. In this paper, we present characteristics of follow-up CT scan and result of the reoperation. Since introduction of CT scan in 1977, we have followed 30 supratentorial malignant gliomas and 16 supratentorial low grade gliomas postoperatively. CT scan was taken in every three months to check the course of contrast enhancement. After removal of the tumor, round low density area appeared on CT scan showing residual cavity. By contrast enhancement, various shape of high density area were seen. We divide the postoperative CT scan in 4 types by mode of contrast enhancement. In the type 1, enhanced area was persistent around the low density area. In the type 2, enhanced area was present around the low density area just after operation, but gradually disappeared. In the type 3, no enhanced area was present. In the type 4, dissemination occurring late after operation. Among the malignant gliomas, 12 cases belonged to the type 1, 6 cases to the type 2, 10 cases to the type 3, and 2 cases to the type 4. Among the low grade gliomas, 3 cases belonged to the type 1, 2 cases to the type 2, and 9 cases to the type 3.(ABSTRACT TRUNCATED AT 250 WORDS)