Ventricular entry during surgical resection is associated with intracranial leptomeningeal dissemination in glioblastoma patients

PURPOSE Glioblastoma (GBM) is associated with a poorer prognosis when leptomeningeal dissemination (LMD) is reported. Recently, the role of both ventricular entry (VE) during surgery and subventricular zone (SVZ) localization of tumors in promoting LMD in GBM patients has been debated. This article investigates the role of leptomeningeal dissemination (LMD) after surgical exeresis of GBM of VE and SVZ location of the tumor. METHODS We conducted a retrospective analysis of GBMs operated on at our Institution between March 2018 and December 2020. We collected pre-and post-surgical images, anamnestic information, and surgical reports. RESULTS Two hundred cases were collected. The GBM localization was periventricular in 69,5% of cases, and there was a VE during the surgical procedure in 51% of cases. The risk of post-surgical LMD in the case of VE was 16%. The rate of LMD was higher in the case of VE than not-VE (27,4% vs. 4%, p < 0.0001). The rate of LMD in periventricular GBM was 19% (p = 0.1131). CONCLUSION According to our data, VE is an independent factor associated with a higher rate of post-surgical LMD, and the periventricular localization is not independently correlated to this negative outcome. Neurosurgeons should avoid VE when possible. The decision should be assessed case by case, and the correct surgical strategy should be founded on balancing the need for maximal EOR and the risks associated with VE.