Surgical resection of gliomas WHO grade II and III located in the opercular region
Surgical resection of gliomas WHO grade II and III located in the opercular region
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DOI：
10.1007/s00701-003-0165-4
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发表时间：
2004-01-01
影响因子：
2.4
通讯作者：
Reulen, HJ
中科院分区：
文献类型：
--
作者：
Peraud, A;Ilmberger, J;Reulen, HJ
背景。由于靠近重要的运动和语言功能区域，在眼区特别是在主导半球的手术对神经外科医生来说是一个重大的挑战。本研究的目的是分析一组同质患者在术前和术后不同语言质量（如失语、失用）方面的功能缺陷，并将这些数据与MR和术中监测结果相关联。14例连续接受手术治疗的疑似低级别星形细胞瘤患者符合本研究的条件（组织学显示3例WHO III级肿瘤）。根据MR上肿瘤的位置和边界、术中神经监测结果和肿瘤切除的程度，回顾性评估术后缺陷的程度和持续时间。术后8例出现言语或语言障碍，4例合并运动障碍，主要为对侧上肢。在接受神经心理学测试的患者中，50%的人表现出语言失用症，而另外50%的人则表现出真正的失语综合征。后一种赤字的恢复通常更快、更彻底。术后缺损的严重程度和持续时间与切除边缘到下一个正刺激点的距离有良好的相关性，超过0.5 cm的距离被证明可以避免重大损伤。与肿瘤扩展相关的功能重要刺激点的分布是不可预测的，并且-出乎意料的是-高达50%的这些点被发现覆盖在肿瘤上。世卫组织II级和III级眼区胶质瘤的手术可导致语言失用或失语综合征，伴或不伴运动缺陷。术中皮质电刺激是必不可少的切除肿瘤在眼窝区域，以避免永久性的发病率。
Background. Surgery in the opercular region especially in the dominant hemisphere impose a major challenge for the neurosurgeon due to the close vicinity to functional important motor and speech areas. The purpose of the present study is to analyse on a homogenous patient group pre- and postoperative functional deficits with regard to different speech qualities (e.g. aphasia, apraxia), and to correlate these data with MR and intraoperative monitoring results.Method. Fourteen patients with suspected low grade astrocytomas in the opercular region consecutively treated by surgery were eligible for this study (histology revealed 3 WHO grade III tumours). Degree and duration of postoperative deficits were retrospectively evaluated according to tumour location and boundaries on MR, intraoperative neuromonitoring results and extent of tumour resection.Findings. Postoperatively, 8 patients showed speech or language disturbances, in 4 patients combined with motor deficits mainly of the contralateral upper extremity. Fifty percent of the neuropsychologically tested patients exhibited speech apraxia while the other 50% had a true aphasic syndrome. Recovery of the latter deficits was in general faster and more complete. The severity and duration of postoperative deficits was in good correlation with the distance of the resection margin to the next positive stimulation point(s), and a distance of more than 0.5 cm proved to avoid major impairments. The distribution of functional important stimulation points in relation to the tumour extension was not predictable, and - unexpectedly - up to 50% of these sites were found overlaying the tumour.Interpretation. Surgery for WHO grade II and III gliomas in the opercular region can result in speech apraxia or an aphasic syndrome with or without concomitant motor deficits. Intraoperative cortical electrical stimulation is essential in resecting tumours in the opercular region to avoid permanent morbidity.