Clinical Neurophysiology, Hospital Universitario de La Princesa, C/Diego de León 62, Madrid, 28006, Spain,
Acta Neurochir (Wien). 2013 Dec;155(12):2201-13. doi: 10.1007/s00701-013-1864-0. Epub 2013 Sep 27.
Fluorescence-guided resection (FGR) using 5-aminolevulinic acid (5-ALA) exhibits a potential risk of permanent neurological deficits that can be minimized using intraoperative neurophysiological monitoring (IONM). We assessed the role of IONM in FGR surgery in patients harboring tumors in or near eloquent areas.
IONM and FGR surgeries were performed on 34 patients (49.8 ± 2.4 years) harbored malignant primary gliomas near eloquent cortical areas or semioval center. Different combinations of neurophysiological techniques were used depending on each patient.
Gross total resection (GTR) was achieved in 66.7 % of the patients, mean 90.4 ± 3.7 % without neurological deficits. Resection in four patients was stopped by the occurrence of severe warning criteria despite the presence of fluorescence. Hemispheric transcranial electrical stimulation was safe and confident even in cortical surgery. Notably, a significant percentage of patients exhibited clinical improvement after the surgery. One week after surgery, only one patient worsened, and seven patients improved. At 3 months, 27.8 % of the patients improved, and the other patients maintained a similar status to their pre-surgery condition. Warning common criteria (amplitude reduction and/or latency increase) appeared in 68.2 and 50.0 % of patients during cortical or semioval surgery, respectively, with neither a false-negative nor a false-positive clinical outcome. Although 5-ALA exhibits phototoxicity, VEP did not induce any secondary effects in the visual system, including eyelids.
IONM can be helpful during surgery to maximize the tumor resection, meanwhile help to avoid neurological deficits and, therefore, to improve the quality of life of these patients.
使用 5-氨基酮戊酸（5-ALA）的荧光引导切除（FGR）存在永久性神经功能缺损的潜在风险，术中神经生理监测（IONM）可将其最小化。我们评估了 IONM 在伴有肿瘤或靠近功能区的患者的 FGR 手术中的作用。
对 34 名（49.8±2.4 岁）患有靠近语言皮质区或半卵圆中心的恶性原发性脑肿瘤的患者进行了 IONM 和 FGR 手术。根据每位患者的不同，采用了不同的神经生理技术组合。
66.7%的患者达到了大体全切除（GTR），无神经功能缺损的平均切除率为 90.4±3.7%。尽管存在荧光，但由于出现严重的预警标准，4 名患者的切除仍被停止。即使在皮质手术中，半球经颅电刺激也是安全和可靠的。值得注意的是，手术后有相当比例的患者表现出临床改善。术后 1 周，只有 1 例患者病情恶化，7 例患者病情改善。3 个月时，27.8%的患者改善，其他患者的状况与术前相似。在皮质或半卵圆中心手术中，分别有 68.2%和 50.0%的患者出现了常见的预警标准（振幅降低和/或潜伏期延长），没有假阴性或假阳性的临床结果。尽管 5-ALA 具有光毒性，但 VEP 并未在视觉系统中引起任何继发性影响，包括眼睑。
IONM 可在手术中提供帮助，以最大限度地切除肿瘤，同时有助于避免神经功能缺损，从而提高这些患者的生活质量。
