Department of Neurosurgery Hospital Universitario I Politècnic La Fe, Valencia, Spain.
Department of Neurosurgery Hospital Universitario I Politècnic La Fe, Valencia, Spain.
Clin Neurol Neurosurg. 2021 Jan;200:106363. doi: 10.1016/j.clineuro.2020.106363. Epub 2020 Nov 11.
The aim of our study was to evaluate the usefulness of cortical-subcortical intraoperative brain mapping (ioBM) in resective awake surgery of low-grade gliomas (LGG) of the right non-dominant hemisphere (RndH). It was estimated how ioBM may affect both the extent of resection and postoperative outcome of language, spatial cognition, social cognition, and executive functions including attention and working memory.
Fifteen patients that underwent ioBM in resective awake surgery of LGG located on the RndH, were included. A cohort of 15 patients with the same tumour location operated under general anaesthesia without brain mapping was used as control. Specific intraoperative tasks for each location were carried out and results registered. Neuropsychological assessment was performed preoperatively and at 6 months after surgery.
In the group of patients operated by using ioBM in awake surgery, an 86.66 % mean of resection was obtained compared to 60.33 % in the control group. Speech arrest and incorrect naming responses were elicited in higher proportion in frontal and insular locations. Parietal stimulation associated higher number of incorrect responses in social cognition task. Parietal and temporal stimulation were more frequently associated with incorrect performance of spatial cognition task. Parietal stimulation associated with higher frequency incorrect execution of attention and working memory tasks. After comparing clinical and neuropsychological results in both cohorts, worst outcome at 6 months was observed in the group of patients operated under general anaesthesia without brain mapping, especially in parietal and insular locations.
Intraoperative identification of language, cognitive functions, and social cognition of RndH by means of ioBM, can be of paramount importance in improving the extent of resection of low-grade gliomas and positively affects clinical and neuropsychological outcome at six months.
本研究旨在评估皮质-皮质下术中脑图（ioBM）在右非优势半球（RndH）低级别胶质瘤（LGG）切除性唤醒手术中的作用。评估 ioBM 如何影响语言、空间认知、社会认知和执行功能（包括注意力和工作记忆）的切除范围和术后结果。
纳入 15 例在 RndH 接受 LGG 切除性唤醒手术且进行 ioBM 的患者。作为对照，选择了一组在全身麻醉下手术且未进行脑图的 15 例具有相同肿瘤位置的患者。为每个位置进行特定的术中任务，并记录结果。在术前和术后 6 个月进行神经心理学评估。
在接受唤醒手术并使用 ioBM 的患者组中，平均切除率为 86.66%，而对照组为 60.33%。额叶和脑岛位置引起的言语中断和错误命名反应的比例更高。顶叶刺激与社会认知任务中更多的错误反应相关。顶叶和颞叶刺激与空间认知任务中更多的错误表现相关。顶叶刺激与注意力和工作记忆任务中更高频率的错误执行相关。比较两组的临床和神经心理学结果后，在未进行脑图的全身麻醉下手术的患者组中观察到 6 个月时的最差结果，尤其是在顶叶和脑岛位置。
通过 ioBM 术中识别 RndH 的语言、认知功能和社会认知，对于提高低级别胶质瘤的切除范围和对术后 6 个月的临床和神经心理学结果有重要意义。
