Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article.
Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article.
复制标题
DOI：
10.3171/2010.6.jns091246
复制
发表时间：
2011-03
影响因子：
4.1
通讯作者：
Berger MS
中科院分区：
文献类型：
--
作者：
Chang EF;Clark A;Smith JS;Polley MY;Chang SM;Barbaro NM;Parsa AT;McDermott MW;Berger MS
低级别胶质瘤（LGG）经常浸润高功能或“功能”脑区。由于缺乏长期生存数据，功能区脑肿瘤位置的预后意义和功能标测在假定功能区脑切除术中的作用尚不清楚。我们对281例在脑肿瘤转诊中心接受幕上LGG切除术的成人病例进行了回顾性分析。术前对MR图像进行盲法评估，以确定是否累及功能脑区，包括感觉运动和语言皮质以及特定的皮质下结构。对于位于假定功能区的高风险肿瘤，评估了接受术中皮层电刺激功能标测的患者和未接受术中皮层电刺激功能标测的患者的长期生存率估计。174例患者（62%）有位于假定功能区的高风险LGG。校正其他已知的预后因素后，假定功能区肿瘤患者的总体和无进展生存期较差（OS，风险比[HR] 6.1，95% CI 2.6-14.1; PFS，HR 1.9，95% CI 1.2-2.9;考克斯比例风险）。术中标测期间确认肿瘤重叠功能区与较短生存期密切相关（OS，HR 9.6，95% CI 3.6-25.9）。相反，当标测显示肿瘤未累及真正的功能区时，患者的生存期显著延长，与术前影像学显示肿瘤仅累及非功能区的患者几乎相当（OS，HR 2.9，95% CI 1.0-8.5）。LGG的假定功能性位置是预测疾病进展和死亡的重要但可改变的风险因素。在高危患者中通过术中标测描绘真实的功能和非功能区域，以最大限度地切除肿瘤，可以显著提高长期生存率。
Low-grade gliomas (LGGs) frequently infiltrate highly functional or “eloquent” brain areas. Given the lack of long-term survival data, the prognostic significance of eloquent brain tumor location and the role of functional mapping during resective surgery in presumed eloquent brain regions are unknown. We performed a retrospective analysis of 281 cases involving adults who underwent resection of a supratentorial LGG at a brain tumor referral center. Preoperative MR images were evaluated blindly for involvement of eloquent brain areas, including the sensorimotor and language cortices, and specific subcortical structures. For high-risk tumors located in presumed eloquent brain areas, long-term survival estimates were evaluated for patients who underwent intraoperative functional mapping with electrocortical stimulation and for those who did not. One hundred and seventy-four patients (62%) had high-risk LGGs that were located in presumed eloquent areas. Adjusting for other known prognostic factors, patients with tumors in areas presumed to be eloquent had worse overall and progression-free survival (OS, hazard ratio [HR] 6.1, 95% CI 2.6–14.1; PFS, HR 1.9, 95% CI 1.2–2.9; Cox proportional hazards). Confirmation of tumor overlapping functional areas during intraoperative mapping was strongly associated with shorter survival (OS, HR 9.6, 95% CI 3.6–25.9). In contrast, when mapping revealed that tumor spared true eloquent areas, patients had significantly longer survival, nearly comparable to patients with tumors that clearly involved only noneloquent areas, as demonstrated by preoperative imaging (OS, HR 2.9, 95% CI 1.0–8.5). Presumed eloquent location of LGGs is an important but modifiable risk factor predicting disease progression and death. Delineation of true functional and nonfunctional areas by intraoperative mapping in high-risk patients to maximize tumor resection can dramatically improve long-term survival.