Gonen Tal, Sela Gal, Yanakee Ranin, Ram Zvi, Grossman Rachel
Department of Neurosurgery, Tel-Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Functional Brain Center, Tel-Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel.
Department of Neurosurgery, Tel-Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
World Neurosurg. 2017 Mar;99:674-679. doi: 10.1016/j.wneu.2016.12.081. Epub 2016 Dec 27.
Despite selection process before awake-craniotomy, some patients experience an unexpected decline in language functions in the operating room (OR), compared with their baseline evaluation, which may impair their functional monitoring. To investigate this phenomenon we prospectively compared language function the day before surgery and on entrance to the OR.
Data were collected prospectively from consecutive patients undergoing awake-craniotomy with intraoperative cortical mapping for resection of gliomas affecting language areas. Language functions of 79 patients were evaluated and compared 1-2 days before surgery and after entering the OR. Changes in functional linguistic performance were analyzed with respect to demographic, clinical, and pathologic characteristics.
There was a significant decline in language function, beyond sedation effect, after entering the OR, (from median/interquartile range: 0.94/0.72-0.98 to median/interquartile range: 0.86/0.51-0.94; Z = -7.19, P < 0.001). Univariate analyses revealed that this decline was related to age, preoperative Karnofsky Performance Scale, tumor location, tumor pathology, and preexisting language deficits. Multivariate stepwise regression identified tumor pathology and the presence of preoperative language deficit as significant independent predictors for this functional decline.
Patients undergoing awake-craniotomy may experience a substantial decline in language functioning after entering the OR. Tumor grade and the presence of preoperative language deficits were significant risk factors for this phenomenon, suggesting a possible relation between cognitive reserve, psychobehavioral coping abilities and histologic features of a tumor involving language areas. Capturing and identifying this unique population of patients who are prone to experience such language decline may improve our ability in the future to select patients eligible for awake-craniotomy.
尽管在清醒开颅手术前进行了筛选过程，但与基线评估相比，一些患者在手术室（OR）中仍会出现意想不到的语言功能下降，这可能会影响其功能监测。为了研究这一现象，我们前瞻性地比较了手术前一天和进入手术室时的语言功能。
前瞻性收集连续接受清醒开颅手术并术中进行皮质映射以切除影响语言区域的胶质瘤患者的数据。对79例患者的语言功能在手术前1 - 2天和进入手术室后进行评估和比较。分析了功能语言表现的变化与人口统计学、临床和病理特征的关系。
进入手术室后，除镇静作用外，语言功能有显著下降（从中位数/四分位间距：0.94/0.72 - 0.98降至中位数/四分位间距：0.86/0.51 - 0.94；Z = -7.19，P < 0.001）。单因素分析显示，这种下降与年龄、术前卡氏评分、肿瘤位置、肿瘤病理和既往语言缺陷有关。多因素逐步回归确定肿瘤病理和术前语言缺陷的存在是这种功能下降的显著独立预测因素。
接受清醒开颅手术的患者进入手术室后可能会出现语言功能的大幅下降。肿瘤分级和术前语言缺陷的存在是这一现象的重要危险因素，提示认知储备、心理行为应对能力与涉及语言区域的肿瘤组织学特征之间可能存在关联。识别出这一容易出现此类语言下降的独特患者群体，可能会提高我们未来选择适合清醒开颅手术患者的能力。
