BACKGROUND: Gliadel (polifeprosan 20 with carmustine [BCNU] implant) is commonly 
used for local delivery of BCNU to high-grade gliomas after resection and is 
associated with increased survival. Various complications of Gliadel wafers have 
been reported but not consistently reproduced. We set out to characterize 
Gliadel-associated morbidity in our 10-year experience with Gliadel wafers for 
treatment of malignant glioma.
METHODS: We retrospectively reviewed records of 1013 patients undergoing 
craniotomy for resection of malignant brain astrocytoma (World Health 
Organization grade III/IV disease). Perioperative morbidity occurring within 3 
months of surgery was assessed for patients and compared between patients 
receiving versus not receiving Gliadel wafer. Overall survival was assessed for 
all patients.
RESULTS: A total of 1013 craniotomies were performed for malignant brain 
astrocytoma. A total of 288 (28%) received Gliadel wafer (250 glioblastoma 
multiforme (GBM), 38 anaplastic astrocytoma/anaplastic oligodendroglioma 
(AA/AO), 166 primary resection, 122 revision resection). Compared with the 
non-Gliadel cohort, patients receiving Gliadel were older (55 +/- 14 vs. 50 +/- 
17, P = .001) and more frequently underwent gross total resection (75% vs 36%, P 
< .01) but otherwise similar. Patients in Gliadel versus non-Gliadel cohorts had 
similar incidences of perioperative surgical site infection (2.8% vs. 1.8%, P = 
.33), cerebrospinal fluid leak (2.8% vs. 1.8%, P = .33), meninigitis (.3% vs. 
.3%, P = 1.00), incisional wound healing difficulty (.7% vs. .4%, P = .63), 
symptomatic malignant edema (2.1% vs. 2.3%, P = 1.00), 3-month seizure incidence 
(14.6% vs. 15.7%, P = .65), deep-vein thrombosis (6.3% vs. 5.2%, P = .53), and 
pulmonary embolism (PE) (4.9% vs. 3.7%, P = .41). For patients receiving Gliadel 
for GBM, median survival was 13.5 months after primary resection (20% alive at 2 
years) and 11.3 months after revision resection (13% alive at 2 years). For 
patients receiving Gliadel for AA/AO, median survival was 57 months after 
primary resection (66% alive at 2 years) and 23.6 months after revision 
resection (47% alive at 2 years).
CONCLUSION: In our experience, use of Gliadel wafer was not associated with an 
increase in perioperative morbidity after surgical treatment of malignant 
astrocytoma.