Ruella Mauro Emiliano, Caffaratti Guido, Villamil Facundo, Crivelli Lucia, Cervio Andrés
Department of Neurosurgery, Fleni, Buenos Aires, Argentina.
Department of Neurosurgery, Fleni, Buenos Aires, Argentina.
World Neurosurg. 2024 Nov;191:e652-e663. doi: 10.1016/j.wneu.2024.09.019. Epub 2024 Sep 10.
To describe our experience in the resection of gliomas involving the insula and analyze the variables implicated in the management and prognosis of these tumors.
This retrospective, single-center, analytic study included a cohort of 83 patients who underwent surgery for insular gliomas by the same surgeon in a third-level Argentine center, in the period between 2010 and 2023. We analyzed the population's demographic, clinical, and radiologic features and surgical variables associated with postoperative results and prognosis using multivariate regression analysis.
A total of 53 patients (54% men) were included, with a mean follow-up of 40.7 months. The mean age at surgery was 41 years (range, 21-73) and 66.1% corresponded to low-grade gliomas (LGGs). Seizures were the initial symptom in most cases. There was evidence of tumor extension over the insula to the temporal or/and frontal lobe in 64.2% of patients. An extent of resection >90% was achieved in 62.3% of cases (27% of gross total resection), with an average resected volume of 89.4%. Awake craniotomy was indicated in 47% of patients and intraoperative magnetic resonance imaging was performed in 24%. Recurrence was observed in 44% of patients, with a mean progression-free survival of 31 months (42 months in LGG and 10 months in high-grade glioma [HGG]). Nine patients underwent reoperation. By the time of 2 years, survival was 100% for LGG and 46% for HGG, whereas 4-year overall survival was 92% for patients with LGG and 15.4% for those with HGG.
Surgery for insular gliomas is a complex task that needs to be managed with adequate preoperative and intraoperative assessment to achieve maximum safe resection with low morbidity for better functional and oncologic outcomes. Adequate anatomic understanding, radiologic analysis, awake craniotomy, and cortical and subcortical mapping are paramount to pursue this aim.
描述我们在切除累及岛叶的胶质瘤方面的经验，并分析与这些肿瘤的管理和预后相关的变量。
这项回顾性、单中心分析研究纳入了2010年至2023年期间在阿根廷一家三级中心由同一位外科医生为岛叶胶质瘤患者实施手术的83例患者。我们使用多因素回归分析，分析了该人群的人口统计学、临床和放射学特征以及与术后结果和预后相关的手术变量。
共纳入53例患者（54%为男性），平均随访40.7个月。手术时的平均年龄为41岁（范围21 - 73岁），66.1%为低级别胶质瘤（LGG）。大多数病例中，癫痫发作是初始症状。64.2%的患者有肿瘤从岛叶延伸至颞叶或/和额叶的证据。62.3%的病例实现了>90%的切除范围（27%为全切），平均切除体积为89.4%。47%的患者采用了清醒开颅手术，24%的患者进行了术中磁共振成像检查。44%的患者出现复发，无进展生存期平均为31个月（LGG为42个月，高级别胶质瘤[HGG]为10个月）。9例患者接受了再次手术。到2年时，LGG患者的生存率为100%，HGG患者为46%；而4年总生存率，LGG患者为92%，HGG患者为15.4%。
岛叶胶质瘤手术是一项复杂的任务，需要进行充分的术前和术中评估，以实现最大程度的安全切除，降低发病率，从而获得更好的功能和肿瘤学结果。充分的解剖学理解、放射学分析、清醒开颅手术以及皮质和皮质下图谱绘制对于实现这一目标至关重要。
