Rossetto Marta, Ciccarino Pietro, Lombardi Giuseppe, Rolma Giuseppe, Cecchin Diego, Della Puppa Alessandro
Department of Neurosurgery, Padua University Hospital, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128, Padova, Italy.
Department of Oncology, IOV IRCCS Oncology Institute of Padua, Via Gattamelata 64, 35128, Padova, Italy.
Neurosurg Rev. 2016 Jan;39(1):71-7; discussion 77-8. doi: 10.1007/s10143-015-0648-9. Epub 2015 Jul 17.
The role of surgery on central area metastasis remains unclear, and outcome data are still controversial. The aim of our study is to analyze the predictive value of clinical and surgical data on motor and functional outcome of patients, taking into account new emerging data on boundary irregularity of brain metastasis. We retrospectively analyzed 47 consecutive patients who underwent surgery assisted by neurophysiologic monitoring for a solitary metastasis in central area between 2010 and 2013. Inclusion criteria were as follows: good functional status (Karnofsky Performance Status (KPS) ≥70), controlled systemic disease, and absence of extra-cranial dissemination. At 1-month follow up, motor and functional outcomes were compared with preoperative clinical status, response to corticosteroids, extent of tumor resection, boundary irregularity, and size of tumor. Gross total resection was achieved in 93.6% of cases. In preoperative symptomatic patients, motor outcome (according to Medical Research Council grading scale) improved in 55.5% and worsened in 16.7%, while functional outcome (according to KPS score) improved in 50% and worsened in 14.2% of cases. No worsening occurred in preoperative asymptomatic patients. Motor outcome resulted to be not correlated with preoperative deficits, tumor volume, or preoperative response to corticosteroid treatment. Remarkably, motor outcome and extent of surgical resection appeared strongly correlated with tumor boundary irregularity (p < 0.05). Surgery with neurophysiologic monitoring on motor area metastasis can improve functional and motor condition in selected patients. Tumor volume does not represent a limit in surgery. The high correlation between clinical outcome, resection rate, and tumor boundary irregularity strengthens a new belief on the infiltrative growing pattern of brain metastasis. Motor function was evaluated according to Medical Research Council grading scale (Ott et al. 2014) while functional status was assessed according to KPS score.
手术对中枢区域转移的作用仍不明确，且结果数据仍存在争议。本研究的目的是分析临床和手术数据对患者运动及功能结局的预测价值，同时考虑到脑转移瘤边界不规则的新出现数据。我们回顾性分析了2010年至2013年间连续47例因中枢区域孤立转移瘤接受神经生理监测辅助手术的患者。纳入标准如下：功能状态良好（卡诺夫斯基功能状态评分（KPS）≥70）、全身疾病得到控制且无颅外播散。在1个月的随访中，将运动和功能结局与术前临床状态、对皮质类固醇的反应、肿瘤切除范围、边界不规则性及肿瘤大小进行比较。93.6%的病例实现了全切除。在术前有症状的患者中，运动结局（根据医学研究理事会分级量表）改善的占55.5%，恶化的占16.7%，而功能结局（根据KPS评分）改善的占50%，恶化的占14.2%。术前无症状的患者未出现恶化情况。运动结局与术前缺陷、肿瘤体积或术前对皮质类固醇治疗的反应无关。值得注意的是，运动结局和手术切除范围与肿瘤边界不规则性密切相关（p＜0.05）。对运动区转移瘤进行神经生理监测的手术可改善部分患者的功能和运动状况。肿瘤体积并非手术的限制因素。临床结局、切除率与肿瘤边界不规则性之间的高度相关性强化了对脑转移瘤浸润性生长模式的新认识。运动功能根据医学研究理事会分级量表（Ott等人，2014年）进行评估，而功能状态根据KPS评分进行评估。
