Ahmed Khan Robert, Rahman Md Moshiur, Ziauddin Md, Chowdhury Muhtamim, Hasan Mahbub
Imperial College Healthcare NHS Trust, London, UK.
Neurosurgery Department, Holy Family Red Crescent Medical College.
Ann Med Surg (Lond). 2024 Feb 28;86(4):1861-1866. doi: 10.1097/MS9.0000000000001837. eCollection 2024 Apr.
INTRODUCTION: Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas. OBJECTIVE: The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not. METHOD: The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months. RESULTS: The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks. CONCLUSION: Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.
引言:直接皮层刺激已被用于清醒患者的脑图谱绘制和明确功能区的定位。这种简化技术用于确定阳性区域,如果肿瘤或病变累及功能区,这些区域可予以保留。 目的:本研究的主要目的是确定清醒状态下低级别胶质瘤患者脑图谱绘制中的直接皮层刺激是否能提高切除率。 方法:作者开展了一项回顾性研究,研究对象为2020年至2022年单中心的35例患者,旨在提高低级别胶质瘤患者清醒开颅手术的切除率及其效果。本研究涉及两名神经外科医生,最短随访时间为12个月。 结果:作者实现了80%的肿瘤切除率。为提高切除率,我们强调在进行解剖学分析之前进行阴性图谱绘制,以了解功能重新定位情况。将对与刺激相关的并发症进行全面讨论,并探讨未来潜在的方向以尽量减少这些问题。作者使用患者报告结果测量信息系统(PROMIS)评分来衡量患者的身心健康状况,并用卡氏评分法来衡量手术成功前后的功能状态。作者发现3例在重复刺激时出现短暂功能缺损的情况。采用低电压频率重复刺激以确定明确功能区是个不错的选择。与刺激相关的面部麻木可能会持续6周。 结论:在进行皮层和皮层下刺激时,可以看到移位脑和水肿中的功能重新定位。大多数从低到高的语言图谱刺激可能因患者而异。为安全切除低级别胶质瘤,需要一条陡峭的学习曲线来找出阴性区域,不过作者强调对区域进行阳性图谱绘制以确保最大程度的功能保留。
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