Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, Frankfurt am Main, 60528, Frankfurt/Main, Germany.
J Neurooncol. 2012 May;107(3):599-607. doi: 10.1007/s11060-011-0784-1. Epub 2012 Jan 17.
The role of repeat resection in the multimodal treatment of gliomas is unclear. Repeat surgery theoretically carries a higher risk of inducing neurological deficits, which might even out any advantage of cytoreduction. We sought to determine whether the occurrence of perioperative infarction is higher for repeat surgery than for first surgery, and sought to identify factors associated with the occurrence of postoperative infarction. Therefore, we searched our database to identify patients who were operated for primary or recurrent glial tumors between October 2007 and October 2010. We analyzed 177 procedures, of which 130 (73.4%) were first surgeries and 47 (26.5%) were repeat. Initial WHO grades, KPS scores, and age were evenly distributed between the groups. Forty-six (26.0%) patients had new DWI lesions on their postoperative MRI scan. Eighteen (10.2%) patients had new lesions greater than 4 cm(3). Among these were 11 (6.2%) patients, for whom the new lesion caused neurologic deficit. There was no difference between first and repeat surgery with regard to the occurrence of new DWI lesions (27.7 vs. 21.3%, P = 0.77) or neurological deficits (10.0 vs. 10.6%, P = 1.0). Tumor location in the insula, operculum, and temporal lobe was found to be significantly associated with the occurrence of new DWI lesions. We conclude that repeat surgery should not be withheld as a treatment option for patients with recurrent gliomas for fear of a higher risk of postoperative infarction or new neurologic deficit than the first surgery.
再次手术在多模式治疗胶质瘤中的作用尚不清楚。理论上，重复手术会带来更高的神经功能缺损风险，甚至可能抵消肿瘤减容的任何优势。我们试图确定再次手术与初次手术相比，围手术期梗死的发生率是否更高，并试图确定与术后梗死发生相关的因素。因此，我们检索了数据库，以确定 2007 年 10 月至 2010 年 10 月期间因原发性或复发性胶质肿瘤而接受手术的患者。我们分析了 177 例手术，其中 130 例（73.4%）为初次手术，47 例（26.5%）为再次手术。两组的初始世界卫生组织分级、KPS 评分和年龄分布均匀。46 例（26.0%）患者在术后 MRI 扫描上出现新的 DWI 病变。18 例（10.2%）患者新的病变大于 4cm³。其中 11 例（6.2%）患者的新病变导致神经功能缺损。再次手术与初次手术相比，新的 DWI 病变的发生率（27.7%比 21.3%，P=0.77）或神经功能缺损的发生率（10.0%比 10.6%，P=1.0）均无差异。发现肿瘤位于岛叶、脑岛、盖和颞叶与新的 DWI 病变的发生显著相关。我们的结论是，对于复发性胶质瘤患者，不应因担心术后梗死或新的神经功能缺损风险高于初次手术而放弃再次手术作为治疗选择。
