Salvati Luca Francesco, De Marco Raffaele, Palmieri Giuseppe, Minardi Massimiliano, Massara Armando, Pesaresi Alessandro, Cagetti Bernarda, Melcarne Antonio, Garbossa Diego
Department of Neurosurgery, Santa Corona Hospital, Asl2 Liguria, 17027 Pietra Ligure, Italy.
Neurosurgery Unit, AOC Città della Salute e della Scienza, Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy.
Brain Sci. 2021 Oct 28;11(11):1436. doi: 10.3390/brainsci11111436.
Gliomas are among the most challenging pathologies for neurosurgeons due to their infiltrative and recurrent nature in functionally relevant regions. Current knowledge confirms that gross total resection highly influence survival in patient with glioma. However, surgery performed in eloquent brain area, could seriously compromise the quality of life in patient with reduced life expectancy even more if it concerns the language function.
18 right-handed patients with perisylvian gliomas on the left hemisphere were prospectively analyzed over a period of 12 months. Standardized preoperative Diffusion-Tensor-Imaging based tractography of the five main language Tracts (Arcuate Fasciculus, Frontal Aslant Tract, Inferior Fronto-Occipital Fasciculus, Inferior Longitudinal Fasciculus, Uncinate Fasciculus) was navigated during the surgical procedure. Using a validated method, correlations were made between the pre-operative fascicles and their possible infiltration and surgical damage. The language status was assessed using the Aachen Aphasia Test.
In all nine patients who developed a permanent disorder there was pre-operative involvement of at least one fascicle and resection of at least one of these. In this way, areas of high risk of permanent language damage have emerged as a result of surgical injury: the temporoparietal junction, the middle portion of the FAT and the temporal stem.
Navigated tractography has proven to be a user-friendly tool that can assess perioperative risk, guide surgical resection, and help the neurosurgeon to find that balance between tumor resection and function preservation.
由于胶质瘤在功能相关区域具有浸润性和复发性，因此对于神经外科医生来说，胶质瘤是最具挑战性的病理类型之一。目前的知识证实，全切除对胶质瘤患者的生存有很大影响。然而，在明确的脑区进行手术，即使涉及语言功能，对于预期寿命缩短的患者来说，也可能严重损害其生活质量。
对18例左侧大脑外侧裂周围胶质瘤的右利手患者进行了为期12个月的前瞻性分析。在手术过程中，对五条主要语言传导束（弓状束、额斜束、额枕下束、颞枕下束、钩束）进行基于术前弥散张量成像的标准化纤维束成像。采用一种经过验证的方法，对术前纤维束与其可能的浸润和手术损伤之间进行相关性分析。使用亚琛失语症测试评估语言状态。
在所有出现永久性障碍的9例患者中，术前至少有一条纤维束受累且至少切除了其中一条。通过这种方式，由于手术损伤，出现了永久性语言损伤的高风险区域：颞顶叶交界处、额斜束中部和颞叶干。
导航纤维束成像已被证明是一种用户友好的工具，它可以评估围手术期风险、指导手术切除，并帮助神经外科医生在肿瘤切除和功能保留之间找到平衡。
