Division of Neurosurgery, Department of Neuroscience and Rehabilitation, University-Hospital S Anna, 203 Cso Giovecca, 44100 Ferrara, Italy.
Neurol Sci. 2011 Oct;32(5):801-10. doi: 10.1007/s10072-011-0587-3. Epub 2011 Apr 13.
Low-grade gliomas are slow-growing tumors invading eloquent areas and white matter pathways. For many decades these tumors were considered inoperable because of their high tropism for eloquent areas. However, the young age of the patients and the inescapable anaplastic transformation have recently suggested more aggressive treatments. We analyzed the neurological and neuro-oncological outcome of 12 patients who underwent surgery fully awake for the resection of LGG, harboring eloquent areas. 10 right- and 2 left-handed patients underwent pre-operative assessment: Karnofsky Performance Status, Edinburgh Handedness Inventory Score; neuropsychological and neurophysiological evaluations, according to the tumor location. During surgery we performed: sensory-motor-evoked potentials, continuous electro-corticography and bipolar/monopolar cortico-subcortical mapping during neuropsychological tests. The resection rate was calculated with neuro-imaging elaboration software. No permanent post-operative deficits were reported; 2 patients improved after surgery. No impairment of cognitive functions was reported. The KPS improved in 8 patients and was steady in the others. The mean resection rate was 78.3%. The resection allowed the control of pre-operative seizures without increasing the drug intake. Awake surgery allowed a good resection rate despite the eloquent location of the tumors, without post-operative deficit. The neuropsychological outcome was unchanged after surgery. The resection seems to improve seizure control. All the patients came back to normal life and work. In conclusion, awake surgery is reliable and feasible in removal of LGG, even if invading the main eloquent areas and networks. All the patients experienced a normal life after surgery, without permanent deficits.
低级别胶质瘤是生长缓慢的肿瘤，侵袭功能区和白质通路。几十年来，由于这些肿瘤对功能区的高亲和力，它们被认为是无法手术的。然而，由于患者年龄较小和不可避免的间变转化，最近建议采用更积极的治疗方法。我们分析了 12 例在完全清醒状态下接受手术切除含有功能区的低级别胶质瘤的患者的神经学和神经肿瘤学结果。10 例右利手和 2 例左利手患者接受了术前评估：卡诺夫斯基行为状态评分、爱丁堡手性量表评分；根据肿瘤位置进行神经心理学和神经生理学评估。在手术中，我们进行了：感觉运动诱发电位、连续皮质脑电图和神经心理学测试期间的双极/单极皮质下映射。使用神经影像学软件计算切除率。没有报告永久性术后缺陷；2 例患者手术后改善。没有报告认知功能受损。8 例患者的 KPS 改善，其余患者稳定。平均切除率为 78.3%。切除允许控制术前癫痫发作，而无需增加药物摄入。尽管肿瘤位于功能区，但清醒手术仍能实现良好的切除率，且无术后缺陷。神经心理学结果在手术后没有改变。切除似乎可以改善癫痫控制。所有患者都恢复了正常的生活和工作。总之，清醒手术在切除低级别胶质瘤时是可靠和可行的，即使肿瘤侵犯主要功能区和网络。所有患者术后都能过上正常的生活，没有永久性缺陷。
