Eseonu Chikezie Ikechukwu, Rincon-Torroella Jordina, Lee Young M, ReFaey Karim, Tripathi Punita, Quinones-Hinojosa Alfredo
Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States.
Department of Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, United States.
J Neurol Surg A Cent Eur Neurosurg. 2018 May;79(3):239-246. doi: 10.1055/s-0037-1617759. Epub 2018 Jan 18.
Perirolandic motor area gliomas present invasive eloquent region tumors within the precentral gyrus that are difficult to resect without causing neurologic deficits.
This study evaluates the role of awake craniotomy and motor mapping on neurologic outcome and extent of resection (EOR) of tumor in the perirolandic motor region. It also analyzes preoperative risk factors for intraoperative seizures.
We evaluated 57 patients who underwent an awake craniotomy for a perirolandic motor area eloquent region glioma. Patients who had positive mapping (PM) or intraoperative identification of motor regions in the cortex using direct cortical stimulation were compared with patients with no positive motor mapping following direct cortical stimulation and negative mapping (NM). Preoperative risks, intraoperative seizures, perioperative outcomes, tumor characteristics, and EOR were also compared. A logistic regression model was used to evaluate the predictors for intraoperative seizures in this patient cohort.
Overall, 33 patients were in the PM cohort; 24 were in the NM cohort. Our study showed an 8.8% incidence of intraoperative seizures during cortical and subcortical mapping for awake craniotomies in the perirolandic motor area, none of which aborted the case. PM patients had significantly more intraoperative and postoperative seizures (15.5% and 30.3%, respectively) compared with the NM patients (0% and 8.3%, respectively; = 0.046 and 0.044). New transient postoperative motor deficits were found more often in the PM group (51.5%) versus the NM group (12.5%; = 0.002). A univariate logistic regression showed that PM (odds ratio [OR]: 1.16; 95% confidence interval [CI], 1.01-1.34; = 0.035) and preoperative tumor volume (OR: 0.998; 95% CI, 0.996-0.999; = 0.049) were significant predictors for intraoperative seizures in patients with perirolandic gliomas.
Awake craniotomies in the perirolandic motor region can be safely performed with a similar incidence of intraoperative seizures as reported for the language cortex. PM in this region may increase the likelihood of perioperative seizures or motor deficits compared with NM. Craniotomies that minimize cortical exposure for perirolandic gliomas that may not localize motor regions can still allow for extensive tumor resection with a good postoperative outcome.
中央前回周围运动区胶质瘤是位于中央前回内的浸润性功能区肿瘤，在不引起神经功能缺损的情况下很难切除。
本研究评估清醒开颅手术和运动功能定位对中央前回周围运动区肿瘤神经功能结局和肿瘤切除范围（EOR）的作用。还分析了术中癫痫发作的术前危险因素。
我们评估了57例因中央前回周围运动区功能区胶质瘤接受清醒开颅手术的患者。将皮层直接电刺激运动功能定位阳性（PM）或术中识别出皮层运动区的患者与皮层直接电刺激后运动功能定位阴性（NM）的患者进行比较。还比较了术前风险、术中癫痫发作、围手术期结局、肿瘤特征和EOR。使用逻辑回归模型评估该患者队列中术中癫痫发作的预测因素。
总体而言，33例患者属于PM队列；24例属于NM队列。我们的研究显示，中央前回周围运动区清醒开颅手术在皮层和皮层下功能定位期间，术中癫痫发作的发生率为8.8%，无一例导致手术终止。与NM患者（分别为0%和8.3%；P = 0.046和0.044）相比，PM患者术中及术后癫痫发作明显更多（分别为15.5%和30.3%）。PM组（51.5%）术后新出现短暂运动功能缺损的情况比NM组（12.5%）更常见（P = 0.002）。单因素逻辑回归显示，PM（比值比[OR]：1.16；95%置信区间[CI]，1.01 - 1.34；P = 0.035）和术前肿瘤体积（OR：0.998；95% CI，0.996 - 0.999；P = 0.049）是中央前回周围胶质瘤患者术中癫痫发作的重要预测因素。
中央前回周围运动区清醒开颅手术可以安全进行，术中癫痫发作发生率与语言皮层报道的相似。与NM相比，该区域的PM可能增加围手术期癫痫发作或运动功能缺损的可能性。对于可能无法定位运动区的中央前回周围胶质瘤，尽量减少皮层暴露的开颅手术仍可实现广泛肿瘤切除，术后结局良好。
