Surgical Resection of Grade II Astrocytomas in the Superior Frontal Gyrus
Surgical Resection of Grade II Astrocytomas in the Superior Frontal Gyrus
复制标题
额上回 II 级星形细胞瘤的手术切除
DOI：
10.1097/00006123-200205000-00009
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发表时间：
2002
期刊：
影响因子：
4.8
通讯作者：
H. Reulen
中科院分区：
文献类型：
--
作者：
A. Peraud;M. Meschede;W. Eisner;J. Ilmberger;H. Reulen
目的：额上级回部分累及辅助运动区（SMA）的手术可能会导致对侧短暂性无力和失语，最初无法与初级运动皮层损伤区分。然而，恢复是不同的，SMA缺陷可能在几天到几周内完全解决。没有研究评估SMA肿瘤切除术后同质患者组的明显术后缺陷。方法对24例世界卫生组织分级为II级的额上级回星形细胞瘤患者进行手术治疗。根据肿瘤位置和边界，通过磁共振成像扫描，术中神经监测结果和肿瘤切除范围，评估术后缺陷的程度和持续时间。结果术后24例患者中21例出现明显的运动障碍，12例患者中9例出现语言障碍。11例运动功能恢复快，3例语言功能恢复快。12例肿瘤后方切除线距离中央前沟超过0.5 cm的患者均未出现持续性运动障碍。这些患者中有8例发生典型SMA综合征，伴有一过性启动困难。12例肿瘤扩展到中央前沟的患者中，7例在12个月随访评估时仍有运动障碍。结论对于额上上级胶质瘤，在距中央前回或正刺激点小于0.5cm的范围内进行手术，更容易导致永久性病变。因此，建议在局部麻醉下，在患者作为自己的监护仪的情况下，对危重病例进行运动和语言功能的皮质标测;切除应量身定制，以获得良好的功能结局并维持生活质量。
OBJECTIVE Surgery in the superior frontal gyrus partially involving the supplementary motor area (SMA) may be followed by contralateral transient weakness and aphasia initially indistinguishable from damage to the primary motor cortex. However, recovery is different, and SMA deficits may resolve completely within days to weeks. No study has assessed the distinct postoperative deficits after tumor resection in the SMA on a homogeneous patient group. METHODS Twenty-four patients with World Health Organization Grade II astrocytomas in the superior frontal gyrus consecutively treated by surgery were studied. Degree and duration of postoperative deficits were evaluated according to tumor location and boundaries via magnetic resonance imaging scans, intraoperative neuromonitoring results, and extent of tumor resection. RESULTS Postoperatively, motor deficits were evident in 21 of 24 and speech deficits in 9 of 12 patients. Motor function quickly recovered in 11 and speech function in 3 patients. None of the 12 patients in whom the posterior tumor resection line was at a distance of more than 0.5 cm from the precentral sulcus experienced persistent motor deficits. Eight of these patients developed typical SMA syndrome with transient initiation difficulties. Seven of 12 patients in whom the tumor extended to the precentral sulcus still had motor deficits at the 12-month follow-up assessment. CONCLUSION Surgery for Grade II gliomas in the superior frontal gyrus is more likely to result in permanent morbidity when the resection is performed at a distance of less than 0.5 cm from the precentral gyrus or positive stimulation points. Therefore, cortical mapping of motor and speech function, in critical cases under local anesthesia with the patient as his or her own monitor, is recommended; resection should be tailored to obtain good functional outcome and maintain quality of life.