Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
PhD. Program of Biomedical Engineering and Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.
J Neurooncol. 2019 May;142(3):577-586. doi: 10.1007/s11060-019-03131-0. Epub 2019 Feb 25.
Awake craniotomy is well-established for tumors resected in eloquent brain areas. Whether awake craniotomy provides improved seizure control in patients with epileptic gliomas has not been well evaluated. This study analyzed the incidence, risk factors and outcome of seizures during and following awake craniotomies for patients presenting with epilepsy and glioma.
Forty-one patients undergoing awake craniotomies for epileptic gliomas were retrospectively analyzed. Postoperative seizure was defined as either early (postoperative day 7 + before) or late onset (after postoperative day 7). Neurologic function was assessed with modified Rankin Scales (mRS) and seizure outcome was assessed using International League Against Epilepsy (ILAE) classification. Multivariable logistic regression was used for clinical variables associated with postoperative seizures.
Three patients (7.3%) had intraoperative seizures however did not fail the awake craniotomies. Mean mRS before and after the awake craniotomies were 2.4 and 2.1, respectively (P = 0.032). Fourteen (34.1%) patients had early seizures, which caused longer hospitalization than those without early seizures (P = 0.03). Surgical resection to isocitrate dehydrogenase 1 (IDH1) mutation tumors, comparing to IDH1 wild type tumors, caused better postoperative seizure control. 6-month late seizure freedom was achieved in 33 patients (80.5%). Early seizure recurrence (odds ratio = 30.75; P = 0.039) and postoperative mRS ≥ 3 (odds ratio = 7.00; P = 0.047) were independent risk factors for late seizures.
Intraoperative seizures could be well-controlled during awake craniotomies. Early postoperative seizures extended hospitalization and strongly predicted late seizure recurrence. Awake craniotomies benefited long-term seizure control in patients with epileptic gliomas.
在语言功能区切除肿瘤时，清醒开颅术已得到广泛应用。然而，对于患有癫痫性胶质瘤的患者，清醒开颅术是否能改善癫痫发作的控制效果，目前尚未得到充分评估。本研究分析了 41 例因癫痫伴发胶质瘤而接受清醒开颅术的患者术中及术后癫痫发作的发生率、风险因素和结局。
回顾性分析了 41 例行清醒开颅术治疗癫痫性胶质瘤的患者。术后癫痫发作定义为早期（术后第 7 天及之前）或晚期（术后第 7 天之后）发作。采用改良 Rankin 量表（mRS）评估神经功能，采用国际抗癫痫联盟（ILAE）分类评估癫痫发作的转归。采用多变量逻辑回归分析与术后癫痫发作相关的临床变量。
3 例（7.3%）患者术中出现癫痫发作，但未导致清醒开颅术失败。清醒开颅术前和术后的平均 mRS 分别为 2.4 和 2.1（P=0.032）。14 例（34.1%）患者出现早期癫痫发作，其住院时间长于无早期癫痫发作的患者（P=0.03）。与 IDH1 野生型肿瘤相比，对 IDH1 突变肿瘤进行手术切除可获得更好的术后癫痫控制效果。33 例（80.5%）患者在 6 个月时实现了晚期无癫痫发作。早期癫痫复发（比值比=30.75；P=0.039）和术后 mRS≥3（比值比=7.00；P=0.047）是晚期癫痫发作的独立危险因素。
在清醒开颅术中可很好地控制术中癫痫发作。术后早期癫痫发作延长了住院时间，并强烈预示着晚期癫痫发作的复发。清醒开颅术使癫痫性胶质瘤患者长期获益于癫痫发作的控制。
