Kim Stefan S, McCutcheon Ian E, Suki Dima, Weinberg Jeffrey S, Sawaya Raymond, Lang Frederick F, Ferson David, Heimberger Amy B, DeMonte Franco, Prabhu Sujit S
Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Neurosurgery. 2009 May;64(5):836-45; discussion 345-6. doi: 10.1227/01.NEU.0000342405.80881.81.
Intraoperative localization of cortical areas for motor and language function has been advocated to minimize postoperative neurological deficits. We report herein the results of a retrospective study of cortical mapping and subsequent clinical outcomes in a large series of patients.
Patients with intracerebral tumors near and/or within eloquent cortices (n = 309) were clinically evaluated before surgery, immediately after, and 1 month and 3 months after surgery. Craniotomy was tailored to encompass tumor plus adjacent areas presumed to contain eloquent cortex. Intraoperative cortical stimulation for language, motor, and/or sensory function was performed in all patients to safely maximize surgical resection.
A gross total resection (> or =95%) was obtained in 64%, and a resection of 85% or more was obtained in 77% of the procedures. Eloquent areas were identified in 65% of cases, and in that group, worsened neurological deficits were observed in 21% of patients, whereas only 9% with negative mapping sustained such deficits (P < 0.01). Intraoperative neurological deficits occurred in 64 patients (21%); of these, 25 (39%) experienced worsened neurological outcome at 1 month, whereas only 27 of 245 patients (11%) without intraoperative changes had such outcomes (P < 0.001). At 1 month, 83% overall showed improved or stable neurological status, whereas 17% had new or worse deficits; however, at 3 months, 7% of patients had a persistent neurological deficit. Extent of resection less than 95% also predicted worsening of neurological status (P < 0.025).
Negative mapping of eloquent areas provides a safe margin for surgical resection with a low incidence of neurological deficits. However, identification of eloquent areas not only failed to eliminate but rather increased the risk of postoperative deficits, likely indicating close proximity of functional cortex to tumor.
为尽量减少术后神经功能缺损，一直提倡在术中对运动和语言功能的皮质区域进行定位。我们在此报告对大量患者进行皮质图谱分析及后续临床结果的回顾性研究结果。
对大脑语言区皮质附近和/或内部患有脑肿瘤的患者（n = 309）在手术前、手术后即刻、术后1个月和3个月进行临床评估。开颅手术范围根据肿瘤及假定包含语言区皮质的相邻区域进行调整。对所有患者进行术中语言、运动和/或感觉功能的皮质刺激，以安全地最大限度切除肿瘤。
64%的手术实现了大体全切（≥95%），77%的手术切除率达到85%或更高。65%的病例中识别出了语言区，在该组中，21%的患者出现神经功能缺损恶化，而在图谱分析为阴性的患者中，只有9%出现此类缺损（P < 0.01）。64例患者（21%）术中出现神经功能缺损；其中，25例（39%）在1个月时神经功能结果恶化，而在术中无变化的245例患者中，只有27例（11%）出现此类结果（P < 0.001）。1个月时，总体83%的患者神经状态改善或稳定，而17%有新的或更严重的缺损；然而，3个月时，7%的患者有持续性神经功能缺损。切除范围小于95%也预示着神经状态会恶化（P < 0.025）。
语言区图谱分析为阴性为手术切除提供了安全边界，神经功能缺损发生率较低。然而，识别出语言区不仅未能消除反而增加了术后缺损的风险，这可能表明功能皮质与肿瘤距离很近。
