الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: A group of 55 adult (≥ 16 years old) patients with cerebral tumors confirmed by histopathological examination to be gliomas were studied in a prospective randomized fashion. All patients after being subjected to thorough clinical and imaging examination, were operated upon in Neurosurgery Department, Zagazig University under general anaesthesia.
Objectives: The aim of this study is evaluation of the results of various management strategies of adult patients with cerebral gliomas including surgery, facilitated by intraoperative ultrasonography, radiotherapy and chemotherapy with addressing impact of the various factors on the outcome.
Patients and methods: Intraoperative ultrasonography used in 25 randomized operations. All patients operated during the period from January 2009 to January 2011 with follow up at least one year for survived patients for evaluation of the results of various management strategies including surgery facilitated by intraoperative ultrasonography, radiotherapy and chemotherapy with addressing impact of various factors on the outcome. At first, a review of the literatures including a detailed study of glial tumors was presented, next the patients data collectively summarized and displayed in tables. The results after being arranged, were analyzed and were compared to those documented in the literatures.
Results: After reviewing the literature and analyzing the results, we can summarize and conclude that gliomas are the most common primary brain tumors and no region of the brain which contain glial tissue is exempted of glioma. There were a lot of glioma classifications and grading and the most recent up to date is the WHO classification and grading in 2007. Cerebral glioma can occur at any age with slight predominance in males. In this study, the youngest age was 17 years and the oldest 77 years with mean age of 43 years and the commonest age group 30-40 years old. Male to female ratio was 1.9:1 with no significant age-sex distributions. The onset of symptoms was gradual in 65.5% and the duration of symptoms ranged from 3 weeks to 8 years with mean duration of 11.4 months and the commonest duraiton of symptoms 3-6 months in 36.4% and ≤ 6 months in 59.1%. Gliomas have no specific clinical features. In this study, the commonest symptoms were headache in 78.2%, motor weankess in 51% and seizures in 47.3%. The commonest signs were papilloedema in 67.3% and motor weakness in 51%. Radiological and imaging data studied carefully for tumor characters and precise location for planning surgery. In this study, right side location was found in 56.4%, one-lobe involvement in 52.7%, three-lobe involvement in one patient and subcortical location in 34.5%. Frontal lobe location was the predominant in 62.1%. Tumor size ≤ 5 cm was found in 52.7%, well-defined edges were found in 34.5%, midline shift in 83.6% and brain oedema in 94.5%. In this study, the pathological types were glioblastoma (GIV) in 21 patients, anaplastic astrocytoma (GIII) in 15 patients, astrocytoma (GII) in 11 patients, pleomorphic xantho-astrocytoma (GII) in 3 patients, pilocytic astrocytoma (GI) in 2 patients, subependymal giant cell astrocytoma (GI) in one patient and mixed glioma in 2 patients; one with mixed anaplastic astrocytoma and oligodendroglioma (GIII) and one with pilocytic astrocytoma with focal oligodendroglioma (GII).
Conclusion: Our patients gave us the clue to the understanding and control of their illness. Cerebral glioma is a devastating disease especially high grades; with all efforts for improving surgical maneuvers, surgical aids, adjuvant therapies and all other types of treatments beside extensive genetic and biological researches, we still in need.