Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California 94143, USA.
Neurosurg Focus. 2010 Feb;28(2):E1. doi: 10.3171/2009.12.FOCUS09266.
Although a primary tenet of neurosurgical oncology is that survival can improve with greater tumor resection, this principle must be tempered by the potential for functional loss following a radical removal. Preoperative planning with functional and physiological imaging paradigms, combined with intraoperative strategies such as cortical and subcortical stimulation mapping, can effectively reduce the risks associated with operating in eloquent territory. In addition to identifying critical motor pathways, these techniques can be adapted to identify language function reliably. The authors review the technical nuances of intraoperative mapping for low- and high-grade gliomas, demonstrating their efficacy in optimizing resection even in patients with negative mapping data. Collectively, these surgical strategies represent the cornerstone for operating on gliomas in and around functional pathways.
尽管神经外科肿瘤学的一个主要原则是，随着肿瘤切除范围的增大，生存时间可以得到改善，但这一原则必须考虑到根治性切除后可能导致的功能丧失。通过功能和生理成像模式进行术前规划，并结合皮质和皮质下刺激映射等术中策略，可以有效地降低在功能区手术的相关风险。这些技术除了识别关键的运动通路外，还可以被改编用于可靠地识别语言功能。作者回顾了低级别和高级别胶质瘤术中定位的技术细节，证明了即使在定位数据为阴性的患者中，这些技术也可以优化切除范围。总的来说，这些手术策略是在功能通路内和周围进行胶质瘤手术的基石。
