Yazbeck Mohamad, Kassem Nour, Nassar Nabil, Farhat Hadi, Dabboucy Baraa, Tlaiss Yehya, Comair Youssef
Department of Neurosurgery, Lebanese University, Beirut, Lebanon.
Department of Neurosurgery, University of Balamand, Beirut, Lebanon.
Surg Neurol Int. 2024 Jul 5;15:228. doi: 10.25259/SNI_158_2024. eCollection 2024.
Gliomas, the most common primary brain tumors, pose surgical challenges in eloquent cortex regions due to potential deficits affecting patients' quality of life (QOL) and increased mortality risk. This study investigates motor and sensory recovery postresection of Rolandic cortex gliomas in 40 patients, alongside seizure outcomes and the efficacy of intraoperative techniques such as awake craniotomy.
This was a 10-year monocentric retrospective study based on the experience of a neurosurgeon in the resection of Rolandic gliomas and its impact on 40 patients' QOL in a period from 2011 to 2020. The primary outcomes were tumor recurrence and the efficacy of the surgery defined as survival status, seizure status, and sensory and motor neurological deficits. Data collection included demographic, tumor, and surgical outcome variables. The extent of resection (EOR) was classified as gross total resection (GTR) (EOR ≥95%) or subtotal resection (EOR <95%). Statistical analysis involved descriptive statistics and inferential tests for outcome comparisons.
Patients were aged an average of 42.3 ± 14 years and distributed between 72.5% of males and 27.5% of females. The most common presentation was seizures (65%). The tumor was located in the frontal lobe at 65%, the motor at 75%, and the top tumor pathology was oligodendroglioma (42.5%). The recurrence rate in the study was 20% (8 of 40), and the 1-year survival rate was 92.5%. After the resection, significant improvement was shown in Karnofsky's performance status ( = 0.007), in normal daily activities ( = 0.001), in fine motor skills ( = 0.020), and work hobbies ( = 0.046). No statistically significant improvement was shown in seizures and deficit rates. Recurrence was not associated with the demographic characteristics, clinical presentation, tumor-related characteristics (location, area, side, and mutation), tumor resection, and adjuvant treatment ( > 0.05).
GTR of Rolandic gliomas can be achieved with the use of meticulous stimulation mapping, and complete functional recovery is attainable despite common belief.
胶质瘤是最常见的原发性脑肿瘤，由于可能导致影响患者生活质量（QOL）的功能缺陷以及增加死亡风险，在明确的皮质区域进行手术具有挑战性。本研究调查了40例罗兰多皮质胶质瘤切除术后的运动和感觉恢复情况，以及癫痫发作结果和术中技术（如清醒开颅手术）的疗效。
这是一项为期10年的单中心回顾性研究，基于一名神经外科医生在2011年至2020年期间切除罗兰多胶质瘤的经验及其对40例患者生活质量的影响。主要结局为肿瘤复发以及定义为生存状态、癫痫发作状态、感觉和运动神经功能缺损的手术疗效。数据收集包括人口统计学、肿瘤和手术结局变量。切除范围（EOR）分为全切除（GTR）（EOR≥95%）或次全切除（EOR<95%）。统计分析包括描述性统计和用于结局比较的推断性检验。
患者平均年龄为42.3±14岁，男性占72.5%，女性占27.5%。最常见的表现是癫痫发作（65%）。肿瘤位于额叶的占65%，运动区的占75%，肿瘤的主要病理类型是少突胶质细胞瘤（42.5%）。该研究中的复发率为20%（40例中的8例），1年生存率为92.5%。切除术后，卡诺夫斯基功能状态评分（=0.007）、正常日常活动（=0.001）、精细运动技能（=0.020）和工作爱好（=0.046）均有显著改善。癫痫发作和功能缺损率未显示出统计学上的显著改善。复发与人口统计学特征、临床表现、肿瘤相关特征（位置、面积、侧别和突变）、肿瘤切除及辅助治疗均无关联（>0.05）。
使用精细的刺激图谱可以实现罗兰多胶质瘤的全切除，尽管普遍认为无法实现，但仍可实现完全功能恢复。
