清醒状态下基于神经图谱的低级别胶质瘤手术后认知功能保留：一项前瞻性、单病例研究。
Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: A longitudinal, within-patient design study.
机构信息
Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.
出版信息
Neuro Oncol. 2022 May 4;24(5):781-793. doi: 10.1093/neuonc/noab275.
BACKGROUND
Awake surgery with intraoperative electrical mapping emerged as a gold-standard approach in newly diagnosed diffuse low-grade glioma (DLGG) to optimize the extent of resection (EOR) while sparing critical brain structures. However, no study has assessed to what extent cognitive recovery occurs following awake mapping-guided neurosurgery in a large, longitudinal, and homogeneous series of DLGG.
METHODS
A longitudinal study on the cognitive status of 157 DLGG patients was performed. Neuropsychological assessments were done before and three months after awake mapping-based surgery. Z-scores and variations of Z-scores were computed to determine the number of patients with cognitive deficit(s) or decline. Clinical, surgical, and histopathological variables were studied to investigate factors contributing to neurocognitive outcomes.
RESULTS
Eighty-seven patients (55.4%) had preoperative cognitive impairments. Statistical analysis between the preoperative (baseline) and postoperative assessments demonstrated a significant difference in three domains (Executive, Psychomotor Speed and Attention, Verbal Episodic Memory). Eighty-six percent of patients exhibited no postoperative cognitive decline, and among them, 10% exhibited cognitive improvement. The mean EOR was 92.3%±7.8%. The EOR, postoperative volume, and tumor lateralization had a significant association with cognitive decline. No patients demonstrated permanent postoperative neurologic deficits, but 5.8% did not resume their preoperative professional activities. The 5-year survival rate was 82.2%.
CONCLUSIONS
This is the largest series ever reported with systematic longitudinal neuropsychological assessment. 86% of patients demonstrated no cognitive decline despite large resections and only 5.8% did not return to work. This work supports the practice of awake surgery with cognitive mapping as safe and effective in DLGG patients.
背景
术中电描记术引导的清醒手术已成为新诊断的弥漫性低级别胶质瘤（DLGG）的金标准方法，可优化切除范围（EOR），同时保留关键的脑结构。然而，尚无研究评估在大型、纵向和同质的 DLGG 系列中，清醒映射引导神经外科手术后认知恢复的程度。
方法
对 157 例 DLGG 患者的认知状态进行了一项纵向研究。在清醒映射引导手术前和术后 3 个月进行神经心理学评估。计算 Z 分数和 Z 分数的变化，以确定有认知缺陷或下降的患者数量。研究了临床、手术和组织病理学变量，以调查影响神经认知结果的因素。
结果
87 例患者（55.4%）术前存在认知障碍。术前（基线）和术后评估之间的统计分析显示，在三个领域（执行、精神运动速度和注意力、言语情节记忆）存在显著差异。86%的患者无术后认知下降，其中 10%表现出认知改善。平均 EOR 为 92.3%±7.8%。EOR、术后体积和肿瘤侧化与认知下降有显著关联。无患者出现永久性术后神经功能缺损，但 5.8%未恢复术前的职业活动。5 年生存率为 82.2%。
结论
这是迄今为止报告的最大系列，具有系统的纵向神经心理学评估。尽管进行了大切除，但 86%的患者无认知下降，只有 5.8%的患者无法恢复工作。这项工作支持在 DLGG 患者中进行清醒手术和认知映射的安全性和有效性。
Zotero 插件