Reitz Sarah Christina, Behrens Marion, Lortz Irina, Conradi Nadine, Rauch Maximilian, Filipski Katharina, Voss Martin, Kell Christian, Czabanka Marcus, Forster Marie-Therese
Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
Front Oncol. 2022 Apr 7;12:815733. doi: 10.3389/fonc.2022.815733. eCollection 2022.
Gliomas are often diagnosed due to epileptic seizures as well as neurocognitive deficits. First treatment choice for patients with gliomas in speech-related areas is awake surgery, which aims at maximizing tumor resection while preserving or improving patient's neurological status. The present study aimed at evaluating neurocognitive functioning and occurrence of epileptic seizures in patients suffering from gliomas located in language-related areas before and after awake surgery as well as during their follow up course of disease.
In this prospective study we included patients who underwent awake surgery for glioma in the inferior frontal gyrus, superior temporal gyrus, or anterior temporal lobe. Preoperatively, as well as in the short-term (median 4.1 months, IQR 2.1-6.0) and long-term (median 18.3 months, IQR 12.3-36.6) postoperative course, neurocognitive functioning, neurologic status, the occurrence of epileptic seizures and number of antiepileptic drugs were recorded.
Between 09/2012 and 09/2019, a total of 27 glioma patients, aged 36.1 ± 11.8 years, were included. Tumor resection was complete in 15, subtotal in 6 and partial in 6 patients, respectively. While preoperatively impairment in at least one neurocognitive domain was found in 37.0% of patients, postoperatively, in the short-term, 36.4% of patients presented a significant deterioration in word fluency (p=0.009) and 34.8% of patients in executive functions (p=0.049). Over the long-term, scores improved to preoperative baseline levels. The number of patients with mood disturbances significantly declined from 66.7% to 34.8% after surgery (p=0.03). Regarding seizures, these were present in 18 (66.7%) patients prior to surgery. Postoperatively, 22 (81.5%) patients were treated with antiepileptic drugs with all patients presenting seizure-freedom.
In patients suffering from gliomas in eloquent areas, the combination of awake surgery, regular neurocognitive assessment - considering individual patients´ functional outcome and rehabilitation needs - and the individual adjustment of antiepileptic therapy results in excellent patient outcome in the long-term course.
胶质瘤常因癫痫发作以及神经认知缺陷而被诊断出来。对于语言相关区域胶质瘤患者，首选治疗方法是清醒开颅手术，其目的是在保留或改善患者神经状态的同时最大限度地切除肿瘤。本研究旨在评估语言相关区域胶质瘤患者在清醒开颅手术前后以及疾病随访过程中的神经认知功能和癫痫发作情况。
在这项前瞻性研究中，我们纳入了在额下回、颞上回或颞叶前部接受清醒开颅手术治疗胶质瘤的患者。在术前、术后短期（中位时间4.1个月，四分位间距2.1 - 6.0）和长期（中位时间18.3个月，四分位间距12.3 - 36.6）记录神经认知功能、神经状态、癫痫发作情况以及抗癫痫药物的数量。
在2012年9月至2019年9月期间，共纳入27例胶质瘤患者，年龄36.1±11.8岁。肿瘤切除情况分别为15例全切、6例次全切和6例部分切除。术前，37.0%的患者至少有一个神经认知领域受损；术后短期内，36.4%的患者单词流畅性显著下降（p = 0.009），34.8%的患者执行功能下降（p = 0.049）。长期来看，分数恢复到术前基线水平。术后情绪障碍患者数量从66.7%显著下降至34.8%（p = 0.03）。关于癫痫发作，术前18例（66.7%）患者有癫痫发作。术后，22例（81.5%）患者接受了抗癫痫药物治疗，所有患者均无癫痫发作。
对于功能区胶质瘤患者，清醒开颅手术、定期神经认知评估（考虑个体患者的功能结局和康复需求）以及抗癫痫治疗的个体化调整相结合，可使患者在长期病程中获得良好的结局。
