Seizure outcome after resection of insular glioma: a systematic review, meta-analysis, and institutional experience.
Seizure outcome after resection of insular glioma: a systematic review, meta-analysis, and institutional experience.
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DOI：
10.3171/2022.8.jns221067
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发表时间：
2023-05-01
影响因子：
4.1
通讯作者：
Berger, Mitchel S.
中科院分区：
文献类型：
--
作者：
Zhang, John J. Y.;Lee, Keng Siang;Wang, Doris D.;Hervey-Jumper, Shawn L.;Berger, Mitchel S.
来自岛叶皮层的胶质瘤可致癫痫，很大一部分患者患有难治性癫痫。手术对此类肿瘤癫痫发作控制的影响尚未得到很好的证实。在这项研究中，作者旨在通过荟萃分析和机构经验调查脑岛胶质瘤切除术后的癫痫发作结果。我们系统地检索了三个数据库（Ovid MEDLINE、Embase和Cochrane Central Register of Controlled Trials），从数据库建立到2021年3月27日，检索了已发表的关于脑岛胶质瘤切除术后癫痫发作结果的研究。此外，回顾性收集了1997年6月至2015年6月期间在作者所在机构接受岛状胶质瘤切除术的所有成年人（年龄0 ~ 17岁）的数据。主要观察指标为1年癫痫发作自由率和最后一次随访。次要结局指标包括术后超过90天的持续神经功能缺损、死亡率、肿瘤进展或复发。荟萃分析纳入了8项研究，报告了453例患者的460例手术。患者的平均年龄为42岁。切除范围(EORs)≥90%、70% - 89%和< 70%的患者的合并百分比分别为55%、33%和11%。1年的合并癫痫发作自由率，IA级为73%，i级为78%。最后一次随访时合并癫痫发作自由率，IA级为60%，i级为79%。超过90天的持续性神经功能障碍合并百分比为3%。在作者所在的机构，109名患者接受了脑岛胶质瘤切除术。较高的EOR是手术后癫痫发作自由的唯一显著独立预测因子（HR 0.290, p = 0.017）。癫痫发作自由的最佳阈值对应于EOR为81%。EOR为0.81%的患者癫痫自由发作率显著高于对照组（OR 2.16, p = 0.048）。最大限度的安全切除可以以最小的手术发病率进行，以获得短期和长期有利的癫痫发作自由率。当不能完全切除时，提高采收率（EOR）为81%，为实现癫痫自由提供了最大的灵敏度和特异性。CRD42021249404 (https://www.crd.york.ac.uk/prospero/)
Gliomas arising from the insular cortex can be epileptogenic, with a significant proportion of patients having medically refractory epilepsy. The impact of surgery on seizure control for such tumors is not well established. In this study, the authors aimed to investigate seizure outcomes after resection of insular gliomas using a meta-analysis and institutional experience. Three databases (Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) were systematically searched for published studies of seizure outcomes after insular glioma resection from database inception to March 27, 2021. In addition, data were retrospectively collected on all adults (age > 17 years) who had undergone insular glioma resection between June 1997 and June 2015 at the authors’ institution. Primary outcome measures were seizure freedom rates at 1 year and the last follow-up. Secondary outcome measures consisted of persistent postoperative neurological deficit beyond 90 days, mortality, and tumor progression or recurrence. Eight studies reporting on 453 patients who had undergone 460 operations were included in the meta-analysis. The pooled mean age of the patients was 42 years. The pooled percentages of patients with extents of resection (EORs) ≥ 90%, 70%–89%, and < 70% were 55%, 33%, and 11%, respectively. The pooled seizure freedom rate at 1 year was 73% for Engel class IA and 78% for Engel class I. The pooled seizure freedom rate at the last follow-up was 60% for Engel class IA and 79% for Engel class I. The pooled percentage of persistent neurological deficit beyond 90 days was 3%. At the authors’ institution, 109 patients had undergone resection of insular glioma. A greater EOR was the only significant independent predictor of seizure freedom after surgery (HR 0.290, p = 0.017). The optimal threshold for seizure freedom corresponded to an EOR of 81%. Patients with an EOR > 81% had a significantly higher seizure freedom rate (OR 2.16, p = 0.048). Maximal safe resection can be performed with minimal surgical morbidity to achieve favorable seizure freedom rates in both the short and long term. When gross-total resection is not possible, an EOR > 81% confers the greatest sensitivity and specificity for achieving seizure freedom. CRD42021249404 (https://www.crd.york.ac.uk/prospero/)