Mandonnet Emmanuel, De Witt Hamer Philip, Poisson Isabelle, Whittle Ian, Bernat Anne-Laure, Bresson Damien, Madadaki Caterina, Bouazza Schahrazed, Ursu Renata, Carpentier Antoine F, George Bernard, Froelich Sébastien
*Department of Neurosurgery, ‖Neurology, and **Department of Anaesthesiology, Lariboisière Hospital, APHP, Paris, France; ‡University Paris 7, Paris, France; §IMNC UMR8165, Orsay, France; ¶Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; #Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom; ‡‡Department of Neuro-oncology, Avicenne Hospital, APHP, Bobigny, France.
Neurosurgery. 2015 Apr;76(4):382-9; discussion 389. doi: 10.1227/NEU.0000000000000644.
Awake glioma surgery aims to maximize resection to optimize prognosis while minimizing the risk of postoperative deficits.
To evaluate oncological, functional, and employment outcomes in the first cohort of patients having this type of surgery at our institution and to determine the effects of any learning curve.
All cases of awake adult (>18 years of age) glioma surgery were recorded between the introduction of this technique in 2011 until the end of 2013. Extent of tumor resection was quantified on magnetic resonance imaging and compared with the objective prediction from a resection probability map. Cognitive status was assessed preoperatively and at 3 months postoperatively. Patients were questioned about their job and capability of working before and after surgery.
Twenty-five patients were included in the analysis. No new motor or language deficits were noted at 6 weeks after surgery. Postoperative magnetic resonance imaging showed complete resection in 11 of 13 patients with glioblastoma and >98% resection in the other 2 patients. For patients with World Health Organization grade II glioma, 3 had total, 4 had subtotal, and 3 had partial resections. Comparison between cognitive levels before and after surgery showed no change in 4 patients, improvement in some tests in 2 patients, and deterioration in some tests in 3 patients. Of 20 patients working at the time of diagnosis, 16 returned to work.
These oncological and functional results of awake glioma surgery during the learning curve are comparable to results from established centers. The use and utility of resection probability maps are well demonstrated. The return to work level is high.
清醒状态下的胶质瘤手术旨在最大程度地切除肿瘤以优化预后，同时将术后功能缺损风险降至最低。
评估在我们机构接受此类手术的首批患者队列的肿瘤学、功能和就业结局，并确定任何学习曲线的影响。
记录了2011年引入该技术至2013年底期间所有清醒状态下的成人（>18岁）胶质瘤手术病例。通过磁共振成像对肿瘤切除范围进行量化，并与切除概率图的客观预测结果进行比较。在术前和术后3个月评估认知状态。询问患者手术前后的工作情况和工作能力。
25例患者纳入分析。术后6周未发现新的运动或语言功能缺损。术后磁共振成像显示，13例胶质母细胞瘤患者中有11例实现了完全切除，另外2例切除率>98%。对于世界卫生组织二级胶质瘤患者，3例实现了全切，4例次全切，3例部分切除。手术前后认知水平比较显示，4例患者无变化，2例患者某些测试结果改善，3例患者某些测试结果恶化。诊断时正在工作的20例患者中，16例恢复了工作。
在学习曲线阶段，清醒状态下胶质瘤手术的这些肿瘤学和功能结果与成熟中心的结果相当。切除概率图的应用和效用得到了充分证明。工作恢复率很高。
