Transcortical insular glioma resection: clinical outcome and predictors
Transcortical insular glioma resection: clinical outcome and predictors
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经皮层岛叶胶质瘤切除术：临床结果和预测因素
DOI：
10.3171/2018.4.jns18424
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发表时间：
2019-09-01
影响因子：
4.1
通讯作者：
Wu, Jinsong
中科院分区：
文献类型：
--
作者：
Hameed, N. U. Farrukh;Qiu, Tianming;Wu, Jinsong
目的岛叶胶质瘤由于其复杂的解剖位置，一直是神经外科医生的难题。经皮质和经侧裂通道仍然是到达小脑顶的主要方法，但采用一种技术而不是另一种仍然存在争议。作者分析了经皮质切除岛叶胶质瘤的方法，在病人的肿瘤位置的基础上的Berger-Sinai分类，可达到的切除程度（EORs），总生存率（OS），和术后神经outcome.METHODS的作者研究了255例连续的岛叶胶质瘤，在他们的分工进行经皮质肿瘤切除术。肿瘤的分子病理学，位置，EOR，术后神经功能的结果为每个岛叶区，并伴随OS纳入分析，以确定这种手术approach.Results的价值低级别岛叶胶质瘤（LGGs）更普遍（63.14%）。关于位置，巨大肿瘤（涉及所有岛叶区）最常见（58.82%），其次是I+IV区（前部）肿瘤（20.39%）。在LGG中，肿瘤位置是生存率的独立预测因素（p = 0.003），巨大肿瘤显示患者生存率最短（p = 0.003）。异柠檬酸脱氢酶1（IDH 1）突变更可能与巨大肿瘤（p < 0.001）相关，而不是位于局部区域的局灶性肿瘤。EOR与LGG（p = 0.001）和高级别胶质瘤（HGG）患者（p = 0.008）的生存率相关。前区LGG的EOR最高（p = 0.024）。在术后神经功能缺损方面，巨大肿瘤患者更易发生（p = 0.038）。术后一过性神经功能缺损占12.79%，永久性神经功能缺损占15.70%。术后出现暂时性或永久性神经功能缺损的患者生存率较低（p < 0.001）。结论：经皮质手术入路可在所有岛叶区实现最大程度的肿瘤切除。此外，将辅助技术（如多模式脑成像和皮层和皮层下功能脑区域的映射）纳入经皮层入路有利于术后神经学结局，并提高患者生存率。
OBJECTIVE Insular lobe gliomas continue to challenge neurosurgeons due to their complex anatomical position. Transcortical and transsylvian corridors remain the primary approaches for reaching the insula, but the adoption of one technique over the other remains controversial. The authors analyzed the transcortical approach of resecting insular gliomas in the context of patient tumor location based on the Berger-Sinai classification, achievable extents of resection (EORs), overall survival (OS), and postsurgical neurological outcome.METHODS The authors studied 255 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Tumor molecular pathology, location, EOR, postoperative neurological outcome for each insular zone, and the accompanying OS were incorporated into the analysis to determine the value of this surgical approach.RESULTS Lower-grade insular gliomas (LGGs) were more prevalent (63.14%). Regarding location, giant tumors (involving all insular zones) were most prevalent (58.82%) followed by zone I+IV (anterior) tumors (20.39%). In LGGs, tumor location was an independent predictor of survival (p = 0.003), with giant tumors demonstrating shortest patient survival (p = 0.003). Isocitrate dehydrogenase 1 (IDH1) mutation was more likely to be associated with giant tumors (p < 0.001) than focal tumors located in a regional zone. EOR correlated with survival in both LGG (p = 0.001) and higher-grade glioma (HGG) patients (p = 0.008). The highest EORs were achieved in anterior-zone LGGs (p = 0.024). In terms of developing postoperative neurological deficits, patients with giant tumors were more susceptible (p = 0.038). Postoperative transient neurological deficit was recorded in 12.79%, and permanent deficit in 15.70% of patients. Patients who developed either transient or permanent postsurgical neurological deficits exhibited poorer survival (p < 0.001).CONCLUSIONS The transcortical surgical approach can achieve maximal tumor resection in all insular zones. In addition, the incorporation of adjunct technologies such as multimodal brain imaging and mapping of cortical and subcortical eloquent brain regions into the transcortical approach favors postoperative neurological outcomes, and prolongs patient survival.