Preserved function in brain invaded by tumor
Preserved function in brain invaded by tumor
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DOI：
10.1097/00006123-199608000-00003
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发表时间：
1996-08-01
期刊：
影响因子：
4.8
通讯作者：
Silbergeld, DL
中科院分区：
文献类型：
--
作者：
Ojemann, JG;Miller, JW;Silbergeld, DL
目的：内在性脑肿瘤可能发生在对语言、运动和体感功能至关重要的皮质区域。尽管人们普遍认为，只要切除的范围限于严重异常的大脑皮层，这类肿瘤是可以安全切除的，但肿瘤切除过程中大脑皮层的功能图谱并不支持这一观点。方法：我们报告了14例不同程度恶性脑肿瘤（4例多形性胶质母细胞瘤，4例间变性星形细胞瘤，2例间变性少突胶质胶质瘤，1例间变性混合胶质瘤，3例神经节胶质瘤）患者的经验（男性9例，女性5例，中位年龄43岁）。术中（n = 11）或术外通过颅内电极（n = 3）进行皮层定位。结果：肿瘤严重侵犯功能皮质（额叶语言皮质4例，颞叶语言皮质5例，运动皮质4例，体感皮质1例）。肿瘤对功能皮层的严重侵犯限制了所有患者的安全切除。三名患者由于切除部位靠近功能皮层而出现短暂的术后功能缺损。1例患者术后迟发性出血，导致持续性运动性失语。结论：本质性脑肿瘤通过正常脑的浸润生长。因此，看起来异常的大脑可能仍保持功能，从而排除了安全的肿瘤切除。
OBJECTIVE: Intrinsic brain tumors can arise within regions of the cortex that are essential to language, motor, and somatosensory functions. Although it is commonly thought that such tumors can be safely resected, as long as the resection is limited to grossly abnormal cortex, functional mapping of the cerebral cortex during tumor resection does not support this contention.METHODS: We report our experience with 14 patients (9 men, 5 women; median age, 43 yr) with intrinsic brain tumors of varying degrees of malignancy (four glioblastomas multiforme, four anaplastic astrocytomas, two anaplastic oligodendrogliomas, one anaplastic mixed glioma, three gangliogliomas). Cortical mapping was performed either intraoperatively (n = 11) or extraoperatively via intracranial electrodes (n = 3).RESULTS: Tumors were found to grossly invade functioning cortices (frontal lobe language cortex, four tumors; temporal lobe language cortex, five tumors; motor cortex, four tumors; somatosensory cortex, one tumor). The gross invasion of functional cortex by tumor limited safe resection in all patients. Three patients experienced transient postoperative deficits caused by the proximity of the resection to functional cortex. One patient suffered a delayed postoperative hemorrhage, with resultant persistent motor aphasia.CONCLUSION: Intrinsic brain tumors grow by infiltration of normal brain. Consequently, brain that appears to be abnormal may remain functional, thus precluding safe tumor resection.