Department of Neurological Surgery, University of California, San Francisco, California, USA.
J Neurosurg. 2011 Mar;114(3):640-7. doi: 10.3171/2010.9.JNS10709. Epub 2010 Oct 8.
The morbidity associated with resection of tumors in the cingulate gyrus (CG) is not well established. The goal of the present study is to define the short- and long-term morbidity profile associated with resection of gliomas within this region.
Ninety consecutive patients with gliomas involving the CG were analyzed. Resections were classified by zones corresponding to functionally defined regions of the CG as follows: Zone I (perigenual, anterior), Zone II (midcingulate), Zone III (posterior), and Zone IV (retrosplenial). Basic demographic, imaging, operative details, and pre- and postoperative neurological examinations were recorded for each patient. Patients in whom neurological morbidity was documented during their initial postoperative examination who did not completely improve by the 6-month follow-up examination were considered to have a permanent deficit. For each patient with surgery-related morbidity, postoperative MR imaging and operative notes were reviewed, and the cortical regions incorporated in the surgical trajectory were recorded. The analysis was carried out for tumors confined to the CG (> 90% of tumor contained within the CG) as well as those involving the CG but extending into adjacent cortical structures.
Analysis of the entire patient cohort demonstrated that 29% of patients experienced a new or worsened neurological deficit immediately after surgery. The most common deficits were supplementary motor area (SMA) syndrome (20%), weakness (6%), and sensory changes (2%). All patients with an SMA syndrome in our series had intentional resection of SMA as part of the surgical approach. Patients with resections including Zone II or III had a higher rate of total morbidity and SMA syndrome than patients with Zone I resections (p < 0.05). Only 4% of patients had a persistent neurological deficit at 6 months postoperatively. A similar morbidity profile was observed in the subset analysis of patients with tumors confined to the CG, with no additional morbidity related to known cingulate-specific functions.
Resection of gliomas involving the CG can be performed with minimal, predictable long-term morbidity (< 5%). Surgical morbidity is primarily a function of surgical trajectory rather than the particular cingulate region resected.
与扣带回肿瘤切除术相关的发病率尚不清楚。本研究的目的是确定与该区域内胶质瘤切除术相关的短期和长期发病率情况。
分析了 90 例累及扣带回的胶质瘤患者。根据与扣带回功能定义区域相对应的区域进行切除分类,如下:区域 I(围胼胝体、前)、区域 II(中央旁小叶)、区域 III(后)和区域 IV(后扣带回)。记录每位患者的基本人口统计学、影像学、手术细节以及术前和术后的神经系统检查。在初始术后检查中记录到神经系统发病率的患者,如果在 6 个月的随访检查中没有完全改善,则被认为存在永久性缺陷。对于每个与手术相关的发病率患者,都对术后磁共振成像和手术记录进行了审查,并记录了纳入手术轨迹的皮质区域。对仅累及扣带回的肿瘤(>90%的肿瘤位于扣带回内)以及累及扣带回但延伸至相邻皮质结构的肿瘤进行了分析。
对整个患者队列的分析表明,29%的患者在手术后立即出现新的或恶化的神经功能缺损。最常见的缺陷是辅助运动区(SMA)综合征(20%)、无力(6%)和感觉变化(2%)。我们系列中所有 SMA 综合征患者均有意切除 SMA,作为手术入路的一部分。包括区域 II 或 III 的切除的患者总发病率和 SMA 综合征发生率高于区域 I 切除的患者(p<0.05)。只有 4%的患者在术后 6 个月时有持续性神经功能缺损。在仅累及扣带回的肿瘤亚组分析中观察到类似的发病率情况,没有与已知扣带特异性功能相关的额外发病率。
切除累及扣带回的胶质瘤可实现最小的、可预测的长期发病率(<5%)。手术发病率主要是手术轨迹的功能,而不是切除的特定扣带区域。