1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University.
2Department of Biostatistics, Medical School of Shanghai Jiaotong University; and.
J Neurosurg. 2018 Oct 19;131(3):706-716. doi: 10.3171/2018.4.JNS18424. Print 2019 Sep 1.
Insular lobe gliomas continue to challenge neurosurgeons due to their complex anatomical position. Transcortical and transsylvian corridors remain the primary approaches for reaching the insula, but the adoption of one technique over the other remains controversial. The authors analyzed the transcortical approach of resecting insular gliomas in the context of patient tumor location based on the Berger-Sinai classification, achievable extents of resection (EORs), overall survival (OS), and postsurgical neurological outcome.
The authors studied 255 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Tumor molecular pathology, location, EOR, postoperative neurological outcome for each insular zone, and the accompanying OS were incorporated into the analysis to determine the value of this surgical approach.
Lower-grade insular gliomas (LGGs) were more prevalent (63.14%). Regarding location, giant tumors (involving all insular zones) were most prevalent (58.82%) followed by zone I+IV (anterior) tumors (20.39%). In LGGs, tumor location was an independent predictor of survival (p = 0.003), with giant tumors demonstrating shortest patient survival (p = 0.003). Isocitrate dehydrogenase 1 (IDH1) mutation was more likely to be associated with giant tumors (p < 0.001) than focal tumors located in a regional zone. EOR correlated with survival in both LGG (p = 0.001) and higher-grade glioma (HGG) patients (p = 0.008). The highest EORs were achieved in anterior-zone LGGs (p = 0.024). In terms of developing postoperative neurological deficits, patients with giant tumors were more susceptible (p = 0.038). Postoperative transient neurological deficit was recorded in 12.79%, and permanent deficit in 15.70% of patients. Patients who developed either transient or permanent postsurgical neurological deficits exhibited poorer survival (p < 0.001).
The transcortical surgical approach can achieve maximal tumor resection in all insular zones. In addition, the incorporation of adjunct technologies such as multimodal brain imaging and mapping of cortical and subcortical eloquent brain regions into the transcortical approach favors postoperative neurological outcomes, and prolongs patient survival.
由于岛叶位置复杂，岛叶胶质瘤仍然是神经外科医生面临的挑战。皮质切开和经颞叶入路仍然是到达岛叶的主要方法，但采用哪种方法仍存在争议。作者根据 Berger-Sinai 分类、可达到的切除程度 (EOR)、总生存率 (OS) 和术后神经功能预后，分析了皮质切开切除岛叶胶质瘤的方法。
作者研究了他们科室连续 255 例接受皮质切开肿瘤切除术的岛叶胶质瘤患者。将肿瘤分子病理学、位置、EOR、每个岛叶区的术后神经功能预后以及伴随的 OS 纳入分析，以确定这种手术方法的价值。
低级别岛叶胶质瘤 (LGGs) 更为常见 (63.14%)。关于位置，巨大肿瘤 (累及所有岛叶区) 最为常见 (58.82%)，其次是 I+IV 区 (前部) 肿瘤 (20.39%)。在 LGG 中，肿瘤位置是生存的独立预测因素 (p = 0.003)，巨大肿瘤患者的生存时间最短 (p = 0.003)。异柠檬酸脱氢酶 1 (IDH1) 突变与巨大肿瘤更相关 (p < 0.001)，而与位于区域性区域的局灶性肿瘤相比。EOR 与 LGG (p = 0.001) 和高级别胶质瘤 (HGG) 患者的生存相关 (p = 0.008)。在前部 LGG 中可获得最高的 EOR (p = 0.024)。就术后发生神经功能缺损而言，巨大肿瘤患者更易发生 (p = 0.038)。术后出现短暂性神经功能缺损的患者占 12.79%，永久性神经功能缺损的患者占 15.70%。出现短暂或永久性术后神经功能缺损的患者生存较差 (p < 0.001)。
皮质切开手术方法可在所有岛叶区实现最大程度的肿瘤切除。此外，将多模态脑成像和皮质及皮质下功能区脑图谱等辅助技术纳入皮质切开入路，可以改善术后神经功能预后，延长患者生存时间。
