Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California, USA.
J Neurosurg. 2011 Mar;114(3):566-73. doi: 10.3171/2010.6.JNS091246. Epub 2010 Jul 16.
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.
低级别胶质瘤（LGG）常浸润高度功能区或“功能区”。由于缺乏长期生存数据，功能区肿瘤位置的预后意义以及在假定功能区进行切除术时进行功能定位的作用尚不清楚。
我们对一家脑肿瘤转诊中心 281 例接受幕上 LGG 切除术的成人患者进行了回顾性分析。术前磁共振成像（MRI）盲法评估肿瘤是否累及功能区，包括感觉运动皮质和语言皮质，以及特定的皮质下结构。对于位于假定功能区的高危肿瘤，评估了接受术中电皮质刺激功能定位的患者和未接受该定位的患者的长期生存估计值。
174 例（62%）患者的高危 LGG 位于假定功能区。在调整其他已知预后因素后，肿瘤位于假定功能区的患者总生存（OS）和无进展生存（PFS）更差（OS，风险比[HR] 6.1，95%可信区间[CI] 2.6-14.1；PFS，HR 1.9，95%CI 1.2-2.9；Cox 比例风险）。术中定位确认肿瘤与功能区重叠与较短的生存时间密切相关（OS，HR 9.6，95%CI 3.6-25.9）。相比之下，当定位显示肿瘤避开了真正的功能区时，患者的生存时间显著延长，几乎与术前影像学显示肿瘤仅明确累及非功能区的患者相当（OS，HR 2.9，95%CI 1.0-8.5）。
LGG 假定的功能区位置是预测疾病进展和死亡的重要但可改变的危险因素。高危患者通过术中定位来明确真正的功能区和非功能区，可以最大限度地切除肿瘤，从而显著提高长期生存率。
