Soumpasis Christos, Díaz-Baamonde Alba, Ghimire Prajwal, Baig Mirza Asfand, Borri Marco, Jarosz Josef, Gullan Richard, Ashkan Keyoumars, Bhangoo Ranjeev, Vergani Francesco, Lavrador Jose Pedro, Mirallave Pescador Ana
Neurosurgical Department, King's College Hospital Foundation Trust, London SE5 9RS, UK.
Department of Neurophysiology, King's College Hospital Foundation Trust, London SE5 9RS, UK.
Cancers (Basel). 2023 Aug 3;15(15):3943. doi: 10.3390/cancers15153943.
Brain tumour surgery in visual eloquent areas poses significant challenges to neurosurgeons and has reported inconsistent results. This is a single-centre prospective cohort study of patients admitted for asleep surgery of intra-axial lesions in visual eloquent areas. Demographic and clinical information, data from tractography and visual evoked potentials (VEPs) monitoring were recorded and correlated with visual outcomes. Thirty-nine patients were included (20 females, 19 males; mean age 52.51 ± 14.08 years). Diffuse intrinsic glioma was noted in 61.54% of patients. There was even distribution between the temporal, occipital and parietal lobes, while 55.26% were right hemispheric lesions. Postoperatively, 74.4% remained stable in terms of visual function, 23.1% deteriorated and 2.6% improved. The tumour infiltration of the optic radiation on tractography was significantly related to the visual field deficit after surgery ( = 0.016). Higher N75 ( = 0.036) and P100 ( = 0.023) amplitudes at closure on direct cortical VEP recordings were associated with no new postoperative visual deficit. A threshold of 40% deterioration of the N75 ( = 0.035) and P100 ( = 0.020) amplitudes correlated with a risk of visual field deterioration. To conclude, direct cortical VEP recordings demonstrated a strong correlation with visual outcomes, contrary to transcranial recordings. Invasion of the optic radiation is related to worse visual field outcomes.
在视觉功能区进行脑肿瘤手术对神经外科医生构成了重大挑战，且报告的结果并不一致。这是一项单中心前瞻性队列研究，研究对象为因视觉功能区轴内病变接受睡眠手术的患者。记录了人口统计学和临床信息、神经纤维束成像数据以及视觉诱发电位（VEP）监测数据，并将其与视觉结果进行关联分析。共纳入39例患者（20例女性，19例男性；平均年龄52.51±14.08岁）。61.54%的患者被诊断为弥漫性固有胶质瘤。病变在颞叶、枕叶和顶叶之间分布均匀，其中55.26%为右半球病变。术后，74.4%的患者视觉功能保持稳定，23.1%的患者视觉功能恶化，2.6%的患者视觉功能改善。神经纤维束成像显示肿瘤对视辐射的浸润与术后视野缺损显著相关（P = 0.016）。直接皮层VEP记录在关闭时较高的N75波幅（P = 0.036）和P100波幅（P = 0.023）与术后无新的视觉缺损相关。N75波幅（P = 0.035）和P100波幅（P = 0.020）下降40%的阈值与视野恶化风险相关。总之，与经颅记录相反，直接皮层VEP记录显示与视觉结果有很强的相关性。视辐射的侵犯与更差的视野结果相关。
