Department of Neurosciences and Rehabilitation, Division of Neurosurgery, S. Anna University Hospital, 203, Corso Giovecca, 44121, Ferrara, Italy.
Acta Neurochir (Wien). 2012 Sep;154(9):1653-62. doi: 10.1007/s00701-012-1416-z. Epub 2012 Jul 26.
Wernicke's area was, for a long time, considered a non-removable area and patients affected by low-grade gliomas (LGGs) or high-grade gliomas (HGGs) in this region were considered inoperable. Several studies have demonstrated a large functional reshaping of language networks in patients affected by gliomas or acute stroke involving Wernicke's territories, and the complete resection of this region invaded by LGG has recently been reported. We report our experience in the removal of Wernicke's territories invaded by gliomas. Four patients underwent awake surgery, with neuropsychological and neurophysiological monitoring and direct cortico-subcortical bipolar stimulation, for resection of LGG (one case) and HGGs (three cases) invading Wernicke's territories. Resection rates were evaluated by means of magnetic resonance imaging (MRI) and computed tomography (CT) perfusion for LGG and HGGs, respectively. HGGs were totally resected and LGG was partially resected (67%), according to functional limits. No patients reported neurological deficit. The patient affected by LGG underwent postoperative chemotherapy. Two of the patients harbouring HGGs died 21 and 23 months after surgery and postoperative adjuvant treatment, respectively. The third one is still alive and progression-free 21 months after surgery. Awake surgery is a reliable and effective technique for resection of gliomas invading Wernicke's territories without postoperative permanent deficit. LGGs in this region can safely be removed, according to the functional subcortical boundaries, allowing postoperative adjuvant treatment, functional reshaping and multi-step surgery. HGGs, instead, can be completely removed without deficits and sometimes beyond the contrast enhancement area, allowing the best possible oncological prognosis for the patients.
韦尼克区很长一段时间以来被认为是不可切除的区域，位于该区的低级别胶质瘤（LGG）或高级别胶质瘤（HGG）患者被认为不能手术。几项研究表明，在涉及韦尼克区的胶质瘤或急性卒中患者中，语言网络会发生很大的功能重塑，最近也有报道称可以完全切除该区域的 LGG 侵犯。我们报告了我们在切除胶质瘤侵犯的韦尼克区的经验。四名患者接受了清醒手术，术中进行了神经心理学和神经生理学监测以及皮质下双极刺激，以切除侵犯韦尼克区的 LGG（1 例）和 HGG（3 例）。通过磁共振成像（MRI）和计算机断层扫描（CT）灌注分别评估 LGG 和 HGG 的切除率。根据功能限制，HGG 被完全切除，LGG 部分切除（67%）。没有患者报告出现神经功能缺损。LGG 患者术后接受了化疗。三例 HGG 患者中，有两名分别在术后 21 个月和 23 个月及术后辅助治疗后死亡，第三名患者仍存活，无瘤生存 21 个月。清醒手术是一种可靠有效的技术，可切除侵犯韦尼克区的胶质瘤，且术后无永久性缺陷。位于该区域的 LGG 可以根据皮质下的功能边界安全切除，允许术后辅助治疗、功能重塑和多步手术。HGG 可以在不出现缺陷的情况下完全切除，有时甚至可以超出对比增强区，从而为患者提供最佳的肿瘤学预后。
