A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations Clinical article
A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations Clinical article
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DOI：
10.3171/2008.8.jns08741
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发表时间：
2009-04-01
影响因子：
4.1
通讯作者：
Duffau, Hugues
中科院分区：
文献类型：
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作者：
Duffau, Hugues
对象。岛上手术的经验很少报道。此外，目前还没有针对WHO II级脑岛胶质瘤的长期随访的大型外科研究。在本文中，作者描述了个人连续系列的51例患者接受手术治疗胰岛II级胶质瘤。在功能和肿瘤结果的基础上，讨论了这种具有挑战性的手术的进展和局限性。51例胰岛II级胶质瘤患者（50例癫痫发作）接受手术治疗。术前神经系统检查正常45例（88%）。所有手术均在皮质-皮质下刺激下进行，其中16例患者在清醒状态下进行。尽管30例（59%）患者术后立即恶化，但除2例（96%）患者外，其余患者的病情均恢复到基线或更好。术后磁共振成像显示77%的切除为全切除或小切除。10名患者接受了第二次或第三次手术，没有额外的缺陷。42例患者（82%）存活，中位随访时间为4年。这是岛状II级胶质瘤手术中最大的报道。对岛岛病理生理学的更好了解和术中功能制图的使用，可以最大限度地降低永久性缺损的风险（甚至可以改善生活质量），同时增加切除的范围，从而对疾病的进程产生影响。因此，对于II级脑胶质瘤必须考虑手术切除。然而，这种手术仍然具有挑战性，特别是在前部穿孔物质和（显性）岛叶后部。在第一次切除不完全的情况下，可以建议进行额外的手术。(DOI: 10.3171 / 2008.8.jns08741)
Object. Few experiences of insular surgery have been reported. Moreover, there are no large surgical studies with long-term follow-up specifically dedicated to WHO Grade II gliomas involving the insula. In this paper, the author describes a personal consecutive series of 51 cases in which patients underwent surgery for an insular Grade II glioma. On the basis of the functional and oncological results, advances and limitations of this challenging surgery are discussed.Methods. Fifty-one patients harboring an insular Grade II glioma (revealed by seizures in 50 cases) underwent surgery. Findings on preoperative neurological examination were normal in 45 patients (88%). All surgeries were conducted under cortico-subcortical stimulation, and in the case of 16 patients while awake.Results. Despite an immediate postoperative worsening in 30 cases (59%), the condition of all but 2 patients (96%) returned to baseline or better. Postoperative MR imaging demonstrated that 77% of resections were total or subtotal. Ten patients underwent a second or third surgery, with no additional deficit. Forty-two patients (82%) are alive with a median follow-up of 4 years.Conclusions. This is the largest reported experience with insular Grade II glioma surgery. The better knowledge of the insular pathophysiology and the use of intraoperative functional mapping allow the risk of permanent deficit to be minimized (and even enable improvement in quality of life) while increasing the extent of resection and thus the impact on the course of the disease. Therefore, surgical removal must always be considered for insular Grade II glioma. However, this surgery remains challenging, especially within the anterior perforating substance and the posterior part of the (dominant) insula. Additional surgery can be suggested in cases in which the first resection is not complete. (DOI: 10.3171/2008.8.JNS08741)