Sun Dongqing, Schaft Eline V, van Stempvoort Bibi M, Gebbink Tineke A, van 't Klooster Maryse, van Eijsden Pieter, van der Salm Sandra M A, Willem Dankbaar Jan, Zijlmans Maeike, Robe Pierre A
Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Neurooncol Adv. 2024 Jul 16;6(1):vdae125. doi: 10.1093/noajnl/vdae125. eCollection 2024 Jan-Dec.
BACKGROUND: Epileptogenesis and glioma growth have a bidirectional relationship. We hypothesized people with gliomas can benefit from the removal of epileptic tissue and that tumor-related epileptic activity may signify tumor infiltration in peritumoral regions. We investigated whether intraoperative electrocorticography (ioECoG) could improve seizure outcomes in oncological glioma surgery, and vice versa, what epileptic activity (EA) tells about tumor infiltration. METHODS: We prospectively included patients who underwent (awake) ioECoG-assisted diffuse-glioma resection through the oncological trajectory. The IoECoG-tailoring strategy relied on ictal and interictal EA (spikes and sharp waves). Brain tissue, where EA was recorded, was assigned for histopathological examination separate from the rest of the tumor. Weibull regression was performed to assess how residual EA and extent of resection (EOR) related to the time-to-seizure recurrence, and we investigated which type of EA predicted tumor infiltration. RESULTS: Fifty-two patients were included. Residual spikes after resection were associated with seizure recurrence in patients with isocitrate dehydrogenase (IDH) mutant astrocytoma or oligodendroglioma (HR = 7.6[1.4-40.0], -value = .01), independent from the EOR. This was not observed in IDH-wildtype tumors. All tissue samples resected based on interictal spikes were infiltrated by tumor, even if the MRI did not show abnormalities. CONCLUSIONS: Complete resection of epileptogenic foci in ioECoG may promote seizure control in IDH-mutant gliomas. The cohort size of IDH-wildtype tumors was too limited to draw definitive conclusions. Interictal spikes may indicate tumor infiltration even when this area appears normal on MRI. Integrating electrophysiology guidance into oncological tumor surgery could contribute to improved seizure outcomes and precise guidance for radical tumor resection.
背景:癫痫发生与胶质瘤生长存在双向关系。我们假设胶质瘤患者可从癫痫组织切除中获益,且肿瘤相关的癫痫活动可能意味着肿瘤在瘤周区域浸润。我们研究了术中皮质脑电图(ioECoG)是否能改善胶质瘤肿瘤手术中的癫痫发作结局,反之,癫痫活动(EA)能揭示哪些关于肿瘤浸润的信息。 方法:我们前瞻性纳入了通过肿瘤手术路径接受(清醒)ioECoG辅助弥漫性胶质瘤切除术的患者。IoECoG调整策略依赖于发作期和发作间期的EA(棘波和尖波)。记录到EA的脑组织与肿瘤其他部分分开进行组织病理学检查。进行威布尔回归分析以评估残余EA和切除范围(EOR)与癫痫复发时间的关系,并研究哪种类型的EA可预测肿瘤浸润。 结果:纳入52例患者。在异柠檬酸脱氢酶(IDH)突变型星形细胞瘤或少突胶质细胞瘤患者中,切除后残余棘波与癫痫复发相关(HR = 7.6[1.4 - 40.0],P值 = 0.01),与EOR无关。在IDH野生型肿瘤中未观察到这种情况。所有基于发作间期棘波切除的组织样本均有肿瘤浸润,即使MRI未显示异常。 结论:ioECoG中癫痫病灶的完全切除可能促进IDH突变型胶质瘤的癫痫控制。IDH野生型肿瘤的队列规模太小,无法得出明确结论。即使该区域在MRI上看起来正常,发作间期棘波也可能提示肿瘤浸润。将电生理指导纳入肿瘤手术可能有助于改善癫痫发作结局并为肿瘤根治性切除提供精确指导。
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