Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
Semin Neurol. 2023 Dec;43(6):810-824. doi: 10.1055/s-0043-1776766. Epub 2023 Nov 14.
The care of patients with both high-grade glioma and low-grade glioma necessitates an interdisciplinary collaboration between neurosurgeons, neuro-oncologists, neurologists and other practitioners. In this review, we aim to detail the considerations, approaches and advances in the neurosurgical care of gliomas. We describe the impact of extent-of-resection in high-grade and low-grade glioma, with particular focus on primary and recurrent glioblastoma. We address advances in surgical methods and adjunct technologies such as intraoperative imaging and fluorescence guided surgery that maximize extent-of-resection while minimizing the potential for iatrogenic neurological deficits. Finally, we review surgically-mediated therapies other than resection and discuss the role of neurosurgery in emerging paradigm-shifts in inter-disciplinary glioma management such as serial tissue sampling and "window of opportunity trials".
高等级和低等级神经胶质瘤患者的护理需要神经外科医生、神经肿瘤学家、神经学家和其他从业者之间的跨学科合作。在这篇综述中，我们旨在详细介绍神经外科治疗神经胶质瘤的注意事项、方法和进展。我们描述了高等级和低等级神经胶质瘤切除范围的影响，特别关注原发性和复发性胶质母细胞瘤。我们讨论了最大限度地扩大切除范围同时最大限度地减少医源性神经功能缺损的潜在风险的手术方法和辅助技术的进展，如术中成像和荧光引导手术。最后，我们回顾了除切除以外的手术介导治疗方法，并讨论了神经外科在神经胶质瘤综合管理中出现的一些范式转变中的作用，如连续组织取样和“机会之窗试验”。
