Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Acta Neurochir (Wien). 2020 Jul;162(7):1709-1720. doi: 10.1007/s00701-020-04357-y. Epub 2020 May 9.
Intraoperative stimulation (IS) mapping has become the preferred standard treatment for eloquent tumors as it permits a more accurate identification of functional areas, allowing surgeons to achieve higher extents of resection (EOR) and decrease postoperative morbidity. For lesions adjacent to the perirolandic area and descending motor tracts, mapping can be done with both awake craniotomy (AC) and under general anesthesia (GA).
We aimed to determine which anesthetic protocol-AC vs. GA-provides better patient outcomes by comparing EOR and postoperative morbidity for surgeries using IS mapping in gliomas located near or in motor areas of the brain.
A systematic literature search was carried out to identify relevant studies from 1983 to 2019. Seven databases were screened. A total of 2351 glioma patients from 17 studies were analyzed.
A random-effects meta-analysis revealed a trend towards a higher mean EOR in AC [90.1% (95% C.I. 85.8-93.8)] than with GA [81.7% (95% C.I. 72.4-89.7)] (p = 0.06). Neurological deficits were divided by timing and severity for analysis. There was no significant difference in early neurological deficits [20.9% (95% C.I. 4.1-45.0) vs. 25.4% (95% C.I. 13.6-39.2)] (p = 0.74), late neurological deficits [17.1% (95% C.I. 0.0-50.0) vs. 3.8% (95% C.I. 1.1-7.6)] (p = 0.06), or in non-severe [28.4% (95% C.I. 0.0-88.5) vs. 20.1% (95% C.I. 7.1-32.2)] (p = 0.72), and severe morbidity [2.6% (95% C.I. 0.0-15.5) vs. 4.5% (95% C.I. 1.1-9.6)] (p = 0.89) between patients who underwent AC versus GA, respectively.
Mapping during resection of gliomas located in or near the perirolandic area and descending motor tracts can be safely carried out with both AC and GA.
术中刺激 (IS) 映射已成为语言相关肿瘤的首选标准治疗方法，因为它可以更准确地识别功能区域，使外科医生能够实现更高的切除范围 (EOR) 并降低术后发病率。对于靠近缘上回区和下行运动束的病变，可以在清醒开颅术 (AC) 和全身麻醉 (GA) 下进行映射。
通过比较使用 IS 映射的手术中 EOR 和术后发病率，确定哪种麻醉方案 - AC 与 GA - 为位于大脑运动区或附近的脑胶质瘤提供更好的患者结局。
进行了系统的文献检索，以从 1983 年到 2019 年确定相关研究。筛选了七个数据库。共分析了来自 17 项研究的 2351 名胶质瘤患者。
随机效应荟萃分析显示，AC 中平均 EOR 呈上升趋势[90.1%（95%CI 85.8-93.8）]，而 GA 中为[81.7%（95%CI 72.4-89.7）]（p=0.06）。神经功能缺损按时间和严重程度进行了分析。早期神经功能缺损无显著差异[20.9%（95%CI 4.1-45.0）与 25.4%（95%CI 13.6-39.2）]（p=0.74），晚期神经功能缺损无显著差异[17.1%（95%CI 0.0-50.0）与 3.8%（95%CI 1.1-7.6）]（p=0.06），非严重神经功能缺损也无显著差异[28.4%（95%CI 0.0-88.5）与 20.1%（95%CI 7.1-32.2）]（p=0.72），严重发病率也无显著差异[2.6%（95%CI 0.0-15.5）与 4.5%（95%CI 1.1-9.6）]（p=0.89）。
在位于缘上回区和下行运动束内或附近的脑胶质瘤切除过程中，可以安全地进行 AC 和 GA 下的映射。
