Department of Neurosurgery, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Department of Biostatistics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Acta Neurochir (Wien). 2019 Jan;161(1):99-107. doi: 10.1007/s00701-018-3732-4. Epub 2018 Nov 21.
Intraoperative stimulation mapping (ISM) using electrocortical mapping (awake craniotomy, AC) or evoked potentials has become a solid option for the resection of supratentorial low-grade gliomas in eloquent areas, but not as much for high-grade gliomas. This meta-analysis aims to determine whether the surgeon, when using ISM and AC, is able to achieve improved overall survival and decreased neurological morbidity in patients with high-grade glioma as compared to resection under general anesthesia (GA).
A systematic search was performed to identify relevant studies. Adult patients were included who had undergone craniotomy for high-grade glioma (WHO grade III or IV) using ISM (among which AC) or GA. Primary outcomes were rate of postoperative complications, overall postoperative survival, and percentage of gross total resections (GTR). Secondary outcomes were extent of resection and percentage of eloquent areas.
Review of 2049 articles led to the inclusion of 53 studies in the analysis, including 9102 patients. The overall postoperative median survival in the AC group was significantly longer (16.87 versus 12.04 months; p < 0.001) and the postoperative complication rate was significantly lower (0.13 versus 0.21; p < 0.001). Mean percentage of GTR was significantly higher in the ISM group (79.1% versus 47.7%, p < 0.0001). Extent of resection and preoperative patient KPS were indicated as prognostic factors, whereas patient KPS and involvement of eloquent areas were identified as predictive factors.
These findings suggest that surgeons using ISM and AC during their resections of high-grade glioma in eloquent areas experienced better surgical outcomes: a significantly longer overall postoperative survival, a lower rate of postoperative complications, and a higher percentage of GTR.
术中刺激映射（ISM）使用皮质电图描记术（清醒开颅术，AC）或诱发电位已成为在功能区切除幕上低级别胶质瘤的可靠选择，但对于高级别胶质瘤并非如此。本荟萃分析旨在确定在使用 ISM 和 AC 时，与全身麻醉（GA）下切除相比，外科医生是否能够提高高级别脑肿瘤患者的总生存率并降低神经发病率。
进行了系统检索以确定相关研究。纳入接受 ISM（包括 AC）或 GA 行开颅术治疗高级别脑肿瘤（世界卫生组织[WHO]分级 III 或 IV 级）的成年患者。主要结局是术后并发症发生率、总术后生存率和大体全切除率（GTR）。次要结局是切除范围和功能区受累比例。
对 2049 篇文章进行综述，分析中纳入了 53 项研究，共 9102 例患者。AC 组的术后中位总生存期明显延长（16.87 个月比 12.04 个月；p<0.001），术后并发症发生率明显降低（0.13 比 0.21；p<0.001）。ISM 组的 GTR 百分比明显更高（79.1%比 47.7%，p<0.0001）。平均切除范围和术前患者 KPS 是预后因素，而患者 KPS 和功能区受累是预测因素。
这些发现表明，在功能区切除高级别脑肿瘤时使用 ISM 和 AC 的外科医生获得了更好的手术结果：总术后生存率显著延长、术后并发症发生率降低、GTR 百分比更高。
