Departments of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
J Neurosurg. 2011 Mar;114(3):576-84. doi: 10.3171/2010.6.JNS091326. Epub 2010 Aug 6.
Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers.
The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated.
In Group A, the median age was 52 years (range 32-78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50-100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively.
Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.
在同一手术中多次开颅切除多个脑转移瘤已取得满意的效果,但这种方法在多灶性和多中心性胶质母细胞瘤治疗中的作用尚不确定,尽管在大多数中心并非标准治疗方法。
作者对 1993 年至 2008 年期间前瞻性收集的数据进行了回顾性分析,共纳入 20 例多灶性或多中心性胶质母细胞瘤患者(A 组),这些患者在同一手术中通过多次开颅手术切除所有病变。选择 20 例接受单一胶质母细胞瘤切除术的患者(B 组)与 A 组进行匹配,匹配变量包括术前 Karnofsky 表现状态(KPS)评分、肿瘤功能分级、切除范围、手术时年龄和手术年份。评估临床和神经外科治疗效果。
A 组患者的中位年龄为 52 岁(范围 32-78 岁);70%为男性;术前 KPS 评分为 80(范围 50-100);9 例为多中心性胶质母细胞瘤,11 例为多灶性胶质母细胞瘤。A 组通过多次开颅手术在同一手术中实现了所有病变的积极切除,中位切除范围为 100%。A 组和 B 组在所有匹配变量以及肿瘤坏死量、囊肿数量和术中导航的使用方面均无显著差异。A 组的总体中位生存时间为 9.7 个月,B 组为 10.5 个月(p = 0.34)。A 组和 B 组(单次开颅手术)的并发症发生率分别为 30%和 35%,30 天死亡率分别为 5%(1 例)和 0%。
在选择的多灶性或多中心性胶质母细胞瘤患者中,积极切除所有病变可获得与单一病变手术患者相似的生存时间,而不会增加术后发病率。这一发现可能表明,在胶质母细胞瘤的治疗中,传统上认为手术治疗作用有限的观点至少应该受到质疑。