Coburger Jan, Onken Julia, Rueckriegel Stefan, von der Brelie Christian, Nadji-Ohl Minou, Forster Marie-Therese, Gerlach Rüdiger, Unteroberdörster Meike, Roder Constantin, Kniese Katja, Schommer Stefan, Rothenbacher Dietrich, Nagel Gabriele, Wirtz Christian Rainer, Ernestus Ralf-Ingo, Nabavi Arya, Tatagiba Marcos, Czabanka Marcus, Ganslandt Oliver, Rohde Veit, Löhr Mario, Vajkoczy Peter, Pala Andrej
Department of Neurosurgery, University of Ulm, Günzburg, Germany.
Department of Neurosurgery, Charité - University of Berlin, Berlin, Germany.
Front Oncol. 2022 Mar 3;12:845992. doi: 10.3389/fonc.2022.845992. eCollection 2022.
Majority of lower grade glioma (LGG) are located eloquently rendering surgical resection challenging. Aim of our study was to assess rate of permanent deficits and its predisposing risk factors. We retrieved 83 patients harboring an eloquently located LGGs from the prospective LoG-Glio Database. Patients without surgery or incomplete postoperative data were excluded. Sign rank test, explorative correlations by Spearman ρ and multivariable regression for new postoperative deficits were calculated. Eloquent region involved predominantly motor (45%) and language (40%). At first follow up after 3 months permanent neuro-logical deficits (NDs) were noted in 39%. Mild deficits remained in 29% and severe deficits in 10%. Complete tumor removal (CTR) was successfully in 62% of intended cases. Postoperative and 3-month follow up National Institute of Health Stroke Score (NIHSS) showed significantly lower values than preoperatively (p<0.001). 38% cases showed a decreased NIHSS at 3-month, while occurrence was only 14% at 9-12-month follow up. 6/7 patients with mild aphasia recovered after 9-12 months, while motor deficits present at 3-month follow up were persistent in majority of patients. Eastern oncology group functional status (ECOG) significantly decreased by surgery (p < 0.001) in 31% of cases. Between 3-month and 9-12-months follow up no significant improvement was seen. In the multivariable model CTR (p=0.019, OR 31.9), and ECOG>0 (p=0.021, OR 8.5) were independent predictors for permanent postoperative deficit according to NIHSS at 3-month according to multivariable regression model. Patients harboring eloquently located LGG are highly vulnerable for permanent deficits. Almost one third of patients have a permanent reduction of their functional status based on ECOG. Risk of an extended resection has to be balanced with the respective oncological benefit. Especially, patients with impaired pre-operative status are at risk for new permanent deficits. There is a relevant improvement of neurological symptoms in the first year after surgery, especially for patients with slight aphasia.
大多数低级别胶质瘤（LGG）位于功能区，这使得手术切除具有挑战性。我们研究的目的是评估永久性神经功能缺损的发生率及其诱发风险因素。我们从前瞻性LoG-Glio数据库中检索了83例功能区定位的LGG患者。排除未接受手术或术后数据不完整的患者。计算了符号秩检验、Spearman ρ探索性相关性以及新的术后神经功能缺损的多变量回归。功能区主要涉及运动区（45%）和语言区（40%）。在术后3个月的首次随访中，39%的患者出现永久性神经功能缺损（NDs）。29%的患者遗留轻度缺损，10%为重度缺损。62%的预期病例成功实现了肿瘤全切（CTR）。术后及3个月随访时的美国国立卫生研究院卒中量表（NIHSS）评分显著低于术前（p<0.001）。38%的病例在3个月时NIHSS评分降低，而在9 - 12个月随访时发生率仅为14%。6/7例轻度失语患者在9 - 12个月后恢复，而3个月随访时出现的运动功能缺损在大多数患者中持续存在。31%的病例中，东部肿瘤协作组功能状态（ECOG）因手术显著下降（p < 0.001）。在3个月至9 - 12个月的随访期间未见明显改善。在多变量模型中，根据多变量回归模型，肿瘤全切（p = 0.019，OR 31.9）和ECOG>0（p = 0.021，OR 8.5）是术后3个月时根据NIHSS评估永久性术后神经功能缺损的独立预测因素。功能区定位的LGG患者极易出现永久性神经功能缺损。几乎三分之一的患者基于ECOG的功能状态出现永久性下降。扩大切除的风险必须与相应的肿瘤学获益相权衡。特别是术前状态受损的患者有出现新的永久性神经功能缺损的风险。术后第一年神经症状有显著改善，尤其是轻度失语患者。
