Department of Neurosurgery, Stanford University, Stanford, California, USA.
Department of Neurosurgery, Stanford University, Stanford, California, USA.
World Neurosurg. 2020 May;137:e328-e335. doi: 10.1016/j.wneu.2020.01.197. Epub 2020 Feb 3.
To compare clinical outcomes and payments between glioma resections with and without functional mapping.
The Thomas Reuters MarketScan national longitudinal database was used to identify patients undergoing resection of supratentorial primary malignant glioma with or without functional mapping between 2007 and 2016. Patients were stratified into mapped and unmapped (conventional) groups and subsequently propensity-matched based on demographics, clinical comorbidities, and surgical characteristics (i.e., use of stereotactic navigation, microscope, and intratumoral chemotherapy). Outcomes and charges were compared between matched groups using bivariate analyses.
A total of 14,037 patients were identified, of whom 796 (6.0%) received functional mapping. Propensity matching (1:1) resulted in 796 mapped patients and 796 propensity-matched controls. Thirty-day postoperative rates of new-onset seizures, cerebral edema, hemorrhage, and neurologic deficits were significantly lower for the functional mapping group (all P < 0.05). Functional mapping was also associated with shorter hospital length of stay (P = 0.0144), lower 30-day rates of emergency department visits (P = 0.0001), and fewer reoperations (P = 0.0068). Total costs of initial admission were not significantly different between groups.
Intraoperative functional mapping during glioma resection was associated with decreased complications, reoperations, emergency department visits, and shorter lengths of stay. Furthermore, total charges of mapped resections were not significantly different from those of conventional resections. These findings support the usefulness of functional mapping for resection of supratentorial primary malignant gliomas.
比较有功能图和无功能图的脑胶质瘤切除术的临床结果和费用。
利用 Thomas Reuters MarketScan 国家纵向数据库，确定了 2007 年至 2016 年间接受幕上原发性恶性脑胶质瘤切除术的患者，包括有和无功能图的患者。将患者分为有图和无图（常规）组，并根据人口统计学、临床合并症和手术特征（即立体定向导航、显微镜和肿瘤内化疗的使用）进行倾向匹配。使用双变量分析比较匹配组之间的结果和费用。
共确定了 14037 例患者，其中 796 例（6.0%）接受了功能图。1:1 的倾向匹配产生了 796 例有图患者和 796 例倾向匹配的对照。术后 30 天新发癫痫、脑水肿、出血和神经功能缺损的发生率，功能图组明显较低（均 P < 0.05）。功能图还与较短的住院时间（P = 0.0144）、较低的术后 30 天急诊就诊率（P = 0.0001）和较少的再次手术（P = 0.0068）相关。两组入院初始费用无显著差异。
脑胶质瘤切除术中的术中功能图与减少并发症、再次手术、急诊就诊和缩短住院时间相关。此外，有图切除的总费用与常规切除无显著差异。这些发现支持在幕上原发性恶性脑胶质瘤切除术中使用功能图的有用性。
