Martino Juan, Taillandier Luc, Moritz-Gasser Sylvie, Gatignol Peggy, Duffau Hugues
Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Av de Valdecilla s/n, Santander, Cantabria, Spain.
Acta Neurochir (Wien). 2009 May;151(5):427-36; discussion 436. doi: 10.1007/s00701-009-0232-6. Epub 2009 Apr 1.
To analyze the functional and oncological results after re-operation for recurrent WHO grade II Glioma located in eloquent regions.
We reviewed a consecutive series of 19 patients with GIIG within functional areas who underwent two operations separated by at least 1 year. Intraoperative electrical stimulation mapping was used in all operations for recurrence and in 14 of the initial procedures. A specific rehabilitation was provided.
At the first operation, we performed 14 subtotal and 5 partial resections. Eighteen patients returned to a normal socio-professional life. Nine patients received adjuvant treatment. At the second operation, we performed 1 total, 13 subtotal and 5 partial resections. Three patients with a preoperative neurological deficit improved, 13 remained unchanged, and 3 slight new deficits appeared. In 14 of the 17 patients with preoperative chronic epilepsy, the seizures were reduced or disappeared. Sixteen patients returned to a normal socio-professional life. Pathohistological examination showed that 11 tumours had progressed to high-grade glioma. The median time between the two operations was 4.1 years (range 1 to 7.8 years) and the median follow-up from initial diagnosis was 6.6 years (range 2.3 to 14.3 years). No deaths occurred during the follow-up period.
Repeat operations guided by intra-operative electrical stimulation is an efficacious treatment for recurrent grade II glioma in an eloquent area.
分析位于功能区的复发性世界卫生组织二级胶质瘤再次手术后的功能和肿瘤学结果。
我们回顾了一系列连续的19例位于功能区的二级胶质瘤患者，他们接受了至少间隔1年的两次手术。所有复发病例的手术及14例初次手术均采用术中电刺激图谱定位，并提供了特定的康复治疗。
首次手术时，我们进行了14次次全切除和5次部分切除。18例患者恢复了正常的社会职业生活。9例患者接受了辅助治疗。第二次手术时，我们进行了1次全切除、13次次全切除和5次部分切除。3例术前有神经功能缺损的患者病情改善，13例无变化，3例出现轻微的新缺损。17例术前患有慢性癫痫的患者中有14例癫痫发作减少或消失。16例患者恢复了正常的社会职业生活。病理组织学检查显示，11例肿瘤已进展为高级别胶质瘤。两次手术之间的中位时间为4.1年（范围1至7.8年），从初次诊断开始的中位随访时间为6.6年（范围2.3至14.3年）。随访期间无死亡病例。
术中电刺激引导下的再次手术是治疗功能区复发性二级胶质瘤的有效方法。
