Departments of 1 Anesthesiology and.
Neurosurgery, St. Olavs University Hospital, Trondheim.
J Neurosurg. 2016 Dec;125(6):1400-1407. doi: 10.3171/2015.12.JNS152252. Epub 2016 Mar 25.
OBJECTIVE Traditionally, the dominant (usually left) cerebral hemisphere is regarded as the more important one, and everyday clinical decisions are influenced by this view. However, reported results on the impact of lesion laterality are inconsistent in the scarce literature on quality of life (QOL) in patients with brain tumors. The authors aimed to study which cerebral hemisphere is the most important to patients with intracranial tumors with respect to health-related QOL (HRQOL). METHODS Two hundred forty-eight patients with unilateral, unifocal gliomas or meningiomas scheduled for primary surgery were included in this prospective cohort study. Generic HRQOL was measured using the EQ-5D-3L questionnaire preoperatively and after 4-6 weeks. Cross-sectional and longitudinal analyses of data were performed. RESULTS Tumor volumes were significantly larger in right-sided tumors at diagnosis, and language or speech problems were more common in left-sided lesions. Otherwise, no differences existed in baseline data. The median EQ-5D-3L index was 0.73 (range -0.24 to 1.00) in patients with right-sided tumors and 0.76 (range -0.48 to 1.00) in patients with left-sided tumors (p = 0.709). Due to the difference in tumor volumes at baseline, histopathology and tumor volumes were matched in 198 patients. EQ-5D-3L index scores in this 1:1 matched analysis were 0.74 (range -0.7 to 1.00) for patients with right-sided and 0.76 (range -0.48 to 1.00) for left-sided lesions (p = 0.342). In the analysis of longitudinal data, no association was found between tumor laterality and postoperative EQ-5D-3L index scores (p = 0.957) or clinically significant change in HRQOL following surgery (p = 0.793). CONCLUSIONS In an overall patient-reported QOL perspective, tumor laterality does not appear to be of significant importance for generic HRQOL in patients with intracranial tumors. This may imply that right-sided cerebral functions are underestimated by clinicians.
传统上，优势（通常为左侧）大脑半球被认为更为重要，并且日常临床决策受到这种观点的影响。然而，在关于脑肿瘤患者生活质量（QOL）的少量文献中，报告的病变侧别的影响结果并不一致。作者旨在研究对于颅内肿瘤患者，哪一侧大脑半球对健康相关 QOL（HRQOL）最重要。
本前瞻性队列研究纳入了 248 例计划行初次手术的单侧、单发胶质瘤或脑膜瘤患者。在术前和术后 4-6 周使用 EQ-5D-3L 问卷测量通用 HRQOL。对数据进行了横断面和纵向分析。
诊断时右侧肿瘤的肿瘤体积明显更大，左侧病变更常见语言或言语问题。否则，基线数据无差异。右侧肿瘤患者的 EQ-5D-3L 指数中位数为 0.73（范围-0.24 至 1.00），左侧肿瘤患者为 0.76（范围-0.48 至 1.00）（p=0.709）。由于基线时肿瘤体积的差异，在 198 例患者中对组织病理学和肿瘤体积进行了匹配。在 1：1 匹配分析中，右侧肿瘤患者的 EQ-5D-3L 指数评分为 0.74（范围-0.7 至 1.00），左侧肿瘤患者为 0.76（范围-0.48 至 1.00）（p=0.342）。在纵向数据分析中，未发现肿瘤侧与术后 EQ-5D-3L 指数评分（p=0.957）或手术后 HRQOL 的临床显著变化（p=0.793）之间存在关联。
从整体患者报告的 QOL 角度来看，肿瘤侧别似乎对颅内肿瘤患者的通用 HRQOL 没有重要意义。这可能意味着临床医生低估了右侧大脑功能。
