Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Neurosurgery. 2023 Jan 1;92(1):125-136. doi: 10.1227/neu.0000000000002149. Epub 2022 Sep 22.
Postoperative ischemia can lead to neurological deficits and is a known complication of glioma resection. There is inconsistency in documented incidence of ischemia after glioma resection, and the precise cause of ischemia is often unknown.
To assess the incidence of postoperative ischemia and neurological deficits after glioma resection and to evaluate their association with potential risk factors.
One hundred thirty-nine patients with 144 surgeries between January 2012 and September 2014 for World Health Organization (WHO) 2016 grade II-IV diffuse supratentorial gliomas with postoperative MRI within 72 hours were retrospectively included. Patient, tumor, and perioperative data were extracted from the electronic patient records. Occurrence of postoperative confluent ischemia, defined as new confluent areas of diffusion restriction, and new or worsened neurological deficits were analyzed univariably and multivariably using logistic regression models.
Postoperative confluent ischemia was found in 64.6% of the cases. Occurrence of confluent ischemia was associated with an insular location ( P = .042) and intraoperative administration of vasopressors ( P = .024) in multivariable analysis. Glioma location in the temporal lobe was related to an absence of confluent ischemia ( P = .01). Any new or worsened neurological deficits occurred in 30.6% and 20.9% at discharge from the hospital and at first follow-up, respectively. Occurrence of ischemia was significantly associated with the presence of novel neurological deficits at discharge ( P = .013) and after 3 months ( P = .024).
Postoperative ischemia and neurological deficit were significantly correlated. Intraoperative administration of vasopressors, insular glioma involvement, and absence of temporal lobe involvement were significantly associated with postoperative ischemia.
术后缺血可导致神经功能缺损，是神经胶质瘤切除术后的已知并发症。文献中记录的神经胶质瘤切除术后缺血发生率存在不一致，且缺血的确切原因通常不明确。
评估神经胶质瘤切除术后缺血和神经功能缺损的发生率，并评估其与潜在危险因素的关系。
回顾性纳入 2012 年 1 月至 2014 年 9 月期间 139 例 144 例接受手术的患者，这些患者均患有世界卫生组织（WHO）2016 级 II-IV 弥漫性幕上神经胶质瘤，术后 72 小时内行 MRI 检查。从电子病历中提取患者、肿瘤和围手术期数据。分析新的、弥漫性的弥散受限区和新发或恶化的神经功能缺损的术后融合性缺血的发生情况，使用逻辑回归模型进行单变量和多变量分析。
64.6%的病例出现术后融合性缺血。多变量分析显示，岛叶部位（ P =.042）和术中使用血管加压素（ P =.024）与融合性缺血的发生相关。颞叶部位的胶质瘤与无融合性缺血相关（ P =.01）。分别有 30.6%和 20.9%的患者在出院和首次随访时出现任何新发或恶化的神经功能缺损。缺血的发生与出院时出现新的神经功能缺损（ P =.013）和 3 个月后（ P =.024）显著相关。
术后缺血和神经功能缺损显著相关。术中使用血管加压素、岛叶胶质瘤受累以及颞叶不受累与术后缺血显著相关。
