Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Occupational therapy, Faculty of health science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
J Neurooncol. 2021 Jan;151(2):221-230. doi: 10.1007/s11060-020-03656-9. Epub 2020 Nov 2.
Awake surgery is the standard treatment to preserve motor and language functions. This longitudinal study aimed to evaluate the resection rate and preservation of neurocognitive functions in patients with right frontal lobe glioma who underwent awake surgery.
Thirty-three patients (mean age, 48.0 years) with right frontal lobe glioma who underwent awake surgery at our hospital between 2013 and 2019 were included. Fourteen, thirteen, and six cases had WHO classification grades of II, III, and IV, respectively. We evaluated visuospatial cognition (VSC) and spatial working memory (SWM) before and three months after surgery. Relevant brain areas for VSC and SWM were intraoperatively mapped, whenever the task was successfully accomplished. Therefore, patients were divided into an intraoperative evaluation group and a non-evaluation group for each function, and the resection rate and functional outcomes were compared.
The removal rate in the evaluation group for VSC and SWM were similar to that in the non-evaluation group. Chronic impairment rate of VSC was significantly lower in the evaluation than in the non-evaluation group (5.6% vs. 33.3%, p = 0.034). No patient showed postoperative SWM impairment in the evaluation group as opposed to the non-evaluation group (16.7%, p = 0.049). The probability of resection of the deeper posterior part of the middle frontal gyrus, the relevant area of VSC, was higher in the non-evaluation group than in the evaluation group.
We statistically verified that awake surgery for right frontal lobe glioma results in successful preservation of VSC and SWM with satisfying resection rates.
唤醒手术是保留运动和语言功能的标准治疗方法。本纵向研究旨在评估接受唤醒手术的右额叶胶质瘤患者的切除率和神经认知功能保留情况。
纳入 2013 年至 2019 年在我院接受唤醒手术的 33 例右额叶胶质瘤患者（平均年龄 48.0 岁）。14、13 和 6 例分别为 WHO 分级 II、III 和 IV 级。我们在术前和术后 3 个月评估了视空间认知（VSC）和空间工作记忆（SWM）。当任务成功完成时，我们对 VSC 和 SWM 的相关脑区进行了术中映射。因此，我们将患者分为每个功能的术中评估组和非评估组，并比较了切除率和功能结果。
VSC 和 SWM 的评估组的切除率与非评估组相似。VSC 的慢性损伤率在评估组明显低于非评估组（5.6% vs. 33.3%，p = 0.034）。在评估组中没有患者出现术后 SWM 损伤，而非评估组则有 16.7%的患者出现（p = 0.049）。VSC 相关区域的中额下回深部后区切除率在非评估组明显高于评估组。
我们通过统计学验证了右额叶胶质瘤的唤醒手术可以成功保留 VSC 和 SWM，同时具有令人满意的切除率。
