Loma Linda University School of Medicine, Loma Linda, California, USA.
Department of Neurological Surgery, University of California, Irvine, California, USA.
World Neurosurg. 2023 Jul;175:e167-e173. doi: 10.1016/j.wneu.2023.03.046. Epub 2023 Mar 15.
Staged surgery for skull base lesions has been utilized to facilitate maximal safe resection and optimize outcomes while minimizing morbidity and complications. Conversely, staged surgery for primary intraparenchymal neoplasms is less commonly performed and has not been reported as extensively within the literature. As such, we performed a systematic review to examine the unique surgical indications for staging, timing between stages, specific surgical approaches utilized, and postoperative complications of staged surgery for primary intra-axial neoplasms.
A literature search was conducted in August 2021 using PubMed, Web of Science, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Titles and abstracts were evaluated independently by 2 authors, after which articles were selected for final analysis based on application of strict inclusion criteria during full text screen. Each included article was then qualitatively assessed and relevant variables-including operative approaches, timing, and outcomes-were extracted for synthesis.
Of 115 results, 7 articles were included for final analysis and consisted of 17 pediatric and 4 adult patients. Staged approaches were more commonly utilized in the pediatric patient population for resection of astrocytoma and glioma. Pediatric patients had a timing of surgeries ranging from 5-10 days between operations, compared with 18 days to 4 months in adult patients. Complications in pediatric patients were most commonly hemiparesis, hydrocephalus, cranial nerve VI and VII palsies, truncal ataxia, and cerebellar mutism, while complications in adult patients included language and abstract thinking deficits, respiratory failure, and motor weakness.
This study reports the first comprehensive review of staged surgical procedures for primary, intra-axial cranial neoplasms. There exists a large degree of heterogeneity in complications resulting from staged surgeries for intra-axial neoplasms, which are similar to complications associated with single-stage surgery for intraparenchymal lesions as well as multi-stage surgeries for skull base lesions.
颅底病变的分期手术已被用于促进最大限度的安全切除，并优化结果，同时将发病率和并发症降至最低。相反，原发性脑内肿瘤的分期手术较少进行，且在文献中报道也不广泛。因此，我们进行了系统评价，以检查分期手术的独特手术指征、分期之间的时间、使用的具体手术方法以及原发性脑内肿瘤分期手术的术后并发症。
2021 年 8 月，我们使用 PubMed、Web of Science 和 Cochrane 数据库按照系统评价和荟萃分析的首选报告项目（PRISMA）建议进行了文献检索。两名作者独立评估标题和摘要，然后根据全文筛选时应用的严格纳入标准选择文章进行最终分析。然后对每个纳入的文章进行定性评估，并提取相关变量，包括手术方法、时间和结果，进行综合分析。
在 115 项结果中，有 7 篇文章被纳入最终分析，包括 17 名儿科患者和 4 名成人患者。分期方法在切除星形细胞瘤和神经胶质瘤的儿科患者中更为常见。儿科患者手术之间的时间间隔为 5-10 天，而成人患者为 18 天至 4 个月。儿科患者的并发症最常见为偏瘫、脑积水、颅神经 VI 和 VII 麻痹、躯干共济失调和小脑缄默症，而成人患者的并发症包括语言和抽象思维缺陷、呼吸衰竭和运动无力。
本研究报告了首次对原发性、脑内轴内肿瘤的分期手术进行全面回顾。由于轴内肿瘤的分期手术而导致的并发症存在很大的异质性，与单发手术治疗脑内病变以及多发手术治疗颅底病变相关的并发症相似。
