Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors
Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors
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DOI：
10.1097/00006123-199805000-00054
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发表时间：
1998-05-01
期刊：
影响因子：
4.8
通讯作者：
Wildrick, DM
中科院分区：
文献类型：
--
作者：
Sawaya, R;Hammoud, M;Wildrick, DM
目的：本研究的目的是严格审查开颅手术切除轴内脑肿瘤后30天内产生的所有并发症，并与可能影响并发症发生率的因素相关，并评估这些数据在预测手术发病率风险方面的价值，特别是对于功能区的手术。我们研究了327名患者的神经外科结局，这些患者在21个月内接受了400例开颅手术，以切除轴向脑实质肿瘤。结果：脑胶质瘤206例，转移瘤194例，其中幕上358例，幕下42例。总体发病率为32%，但与以往研究相比，考虑了更多类型的并发症。主要神经系统疾病发生率为8.5%。根据术前与术后（4周）Karnofsky行为量表评分，9%的患者神经功能恶化，32%改善，58%无变化。术后平均住院时间为5天。根据肿瘤相对于脑功能的位置，将肿瘤定义为I级、II级或III级，该肿瘤功能等级是影响任何神经功能缺损发生率的最重要变量。功能区（III级）或近功能区（II级）肿瘤患者比非功能区（I级）肿瘤患者发生更多的神经功能缺损。复发性疾病的再次手术和手术切除程度均不显著影响预后。尽管本研究中的大多数肿瘤，包括功能区的肿瘤，均通过大体全切除术切除，但这并未导致更严重的神经功能缺损。术前Karnofsky评分较低（550分）和后颅窝肿块的老年患者（年龄>60岁）的局部并发症（手术部位）和全身并发症（内科）更常见。我们表明，我们的数据可以用来预测一个给定的病人的手术发病率的总风险，以方便患者咨询和手术decision-making.CONCLUSION：这一发现，总切除术可以在功能强大的大脑区域进行一个可接受的神经功能缺损水平表明，仅仅存在一个肿瘤在功能强大的大脑不自动禁忌手术。我们的研究结果具有实际的风险预测价值，它们应该有助于后续结果研究的构建，因为我们已经确定了要监测的关键领域。
OBJECTIVE: The goals were to critically review all complications resulting within 30 days after craniotomies performed for excision of intra-axial brain tumors relative to factors likely to affect complication rates and to assess the value of these data in predicting the risk of surgical morbidity, particularly for surgery in eloquent brain regions.METHODS: Neurosurgical outcomes were studied for 327 patients who underwent 400 craniotomies for removal of intra-axial parenchymal brain neoplasms in a 21-month period. Tumors removed included gliomas (206 tumors) and metastases (194 tumors) located both supratentorially (358 tumors) and infratentorially (42 tumors).RESULTS: The major complication incidence was 13%, and the operative mortality rate was 1.7%. The overall morbidity rate was 32%, but more types of complications were considered than in previous studies. The major neurological morbidity rate was 8.5%. Based on pre-versus postoperative (at 4 wk) Karnofsky Performance Scale scores, 9% of patients deteriorated neurologically, 32% improved, and 58% showed no change. The median postoperative hospital stay was 5 days. Tumors were defined as Grade I, II, or III based on their location relative to brain function, and this tumor functional grade was the most important variable affecting the incidence of any neurological deficit. Patients with tumors in eloquent (Grade III) or near-eloquent (Grade II) brain areas incurred more neurological deficits than did patients with tumors in noneloquent areas (Grade I). Neither repeat surgery for recurrent disease nor extent of surgical resection affected outcome significantly. Although most tumors in this study, including those in eloquent regions, were removed by gross total resection, this did not lead to more major neurological deficits. Regional complications (at the surgical sites) and systemic complications (medical) were more prevalent among older patients (age >60 yr) with lower preoperative Karnofsky Performance Scale scores (550) and posterior fossa masses. We showed how our data can be used to predict the total risk of surgical morbidity for a given patient, to facilitate patient counseling and surgical decision-making.CONCLUSION: The finding that gross total resections could be performed in eloquent brain regions with an acceptable level of neurological impairment suggested that the mere presence of a tumor in eloquent brain does not automatically contraindicate surgery. Our results have practical risk-predictive value, and they should aid in the construction of subsequent outcome studies, because we have identified the key areas to monitor.