Kram Leonie, Neu Beate, Schroeder Axel, Wiestler Benedikt, Meyer Bernhard, Krieg Sandro M, Ille Sebastian
Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
Front Hum Neurosci. 2024 May 2;18:1365215. doi: 10.3389/fnhum.2024.1365215. eCollection 2024.
Awake craniotomy is the standard of care for treating language eloquent gliomas. However, depending on preoperative functionality, it is not feasible in each patient and selection criteria are highly heterogeneous. Thus, this study aimed to identify broadly applicable predictor variables allowing for a more systematic and objective patient selection.
We performed post-hoc analyses of preoperative language status, patient and tumor characteristics including language eloquence of 96 glioma patients treated in a single neurosurgical center between 05/2018 and 01/2021. Multinomial logistic regression and stepwise variable selection were applied to identify significant predictors of awake surgery feasibility.
Stepwise backward selection confirmed that a higher number of paraphasias, lower age, and high language eloquence level were suitable indicators for an awake surgery in our cohort. Subsequent descriptive and ROC-analyses indicated a cut-off at ≤54 years and a language eloquence level of at least 6 for awake surgeries, which require further validation. A high language eloquence, lower age, preexisting semantic and phonological aphasic symptoms have shown to be suitable predictors.
The combination of these factors may act as a basis for a systematic and standardized grading of patients' suitability for an awake craniotomy which is easily integrable into the preoperative workflow across neurosurgical centers.
清醒开颅手术是治疗语言功能区胶质瘤的标准治疗方法。然而，根据术前功能情况，并非每位患者都可行，且选择标准高度异质。因此，本研究旨在确定广泛适用的预测变量，以便更系统、客观地选择患者。
我们对2018年5月至2021年1月在单一神经外科中心接受治疗的96例胶质瘤患者的术前语言状态、患者及肿瘤特征（包括语言功能区）进行了事后分析。应用多项逻辑回归和逐步变量选择来确定清醒手术可行性的显著预测因素。
逐步向后选择证实，较多的言语错乱、较低的年龄以及较高的语言功能区水平是我们队列中清醒手术的合适指标。随后的描述性分析和ROC分析表明，对于清醒手术，年龄≤54岁且语言功能区水平至少为6是一个临界值，这需要进一步验证。较高的语言功能区、较低的年龄、既往存在的语义和语音失语症状已被证明是合适的预测因素。
这些因素的组合可作为系统、标准化评估患者适合清醒开颅手术程度的基础，这易于整合到各神经外科中心的术前工作流程中。
