Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.
World Neurosurg. 2024 Jan;181:e483-e492. doi: 10.1016/j.wneu.2023.10.085. Epub 2023 Oct 21.
We examined the utility of passive high gamma mapping (HGM) as an adjunct to conventional awake brain mapping during glioma resection. We compared functional and survival outcomes before and after implementing intraoperative HGM.
This was a retrospective cohort study of 75 patients who underwent a first-time, awake craniotomy for glioma resection. Patients were stratified by whether their operation occurred before or after the implementation of a U.S. Food and Drug Administration-approved high-gamma mapping tool in July 2017.
The preimplementation and postimplementation cohorts included 28 and 47 patients, respectively. Median intraoperative time (261 vs. 261 minutes, P = 0.250) and extent of resection (97.14% vs. 98.19%, P = 0.481) were comparable between cohorts. Median Karnofsky performance status at initial follow-up was similar between cohorts (P = 0.650). Multivariable Cox regression models demonstrated an adjusted hazard ratio for overall survival of 0.10 (95% confidence interval: 0.02-0.43, P = 0.002) for the postimplementation cohort relative to the preimplementation cohort. Progression-free survival adjusted for insular involvement showed an adjusted hazard ratio of 1.00 (95% confidence interval: 0.49-2.06, P = 0.999) following HGM implementation. Falling short of statistical significance, prevalence of intraoperative seizures and/or afterdischarges decreased after HGM implementation as well (12.7% vs. 25%, P = 0.150).
Our results tentatively indicate that passive HGM is a safe and potentially useful adjunct to electrical stimulation mapping for awake cortical mapping, conferring at least comparable functional and survival outcomes with a nonsignificant lower rate of intraoperative epileptiform events. Considering the limitations of our study design and patient cohort, further investigation is needed to better identify optimal use cases for HGM.
我们研究了被动高伽马映射（HGM）作为胶质细胞瘤切除术中常规清醒脑映射辅助手段的效用。我们比较了实施术中 HGM 前后的功能和生存结果。
这是一项回顾性队列研究，共纳入 75 名首次接受清醒开颅术切除胶质细胞瘤的患者。根据其手术时间是在 2017 年 7 月美国食品和药物管理局批准的高伽马映射工具实施之前还是之后，将患者分为两组。
实施前和实施后队列分别纳入 28 例和 47 例患者。两组患者的术中时间（中位数 261 分钟 vs. 261 分钟，P=0.250）和切除范围（中位数 97.14% vs. 98.19%，P=0.481）相似。初始随访时，两组患者的卡诺夫斯基表现状态评分中位数相似（P=0.650）。多变量 Cox 回归模型显示，与实施前队列相比，实施后队列的总生存率调整后危险比为 0.10（95%置信区间：0.02-0.43，P=0.002）。调整岛叶受累后，无进展生存率调整后危险比为 1.00（95%置信区间：0.49-2.06，P=0.999）。虽然没有达到统计学意义，但实施 HGM 后术中癫痫发作和/或术后放电的发生率也有所下降（12.7% vs. 25%，P=0.150）。
我们的结果初步表明，被动 HGM 是一种安全且潜在有用的电刺激映射辅助手段，用于清醒皮质映射，可提供至少相当的功能和生存结果，且术中癫痫样事件发生率显著降低。考虑到我们的研究设计和患者队列的局限性，需要进一步研究以更好地确定 HGM 的最佳应用情况。
