Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan;
Anticancer Res. 2024 Oct;44(10):4609-4615. doi: 10.21873/anticanres.17291.
BACKGROUND/AIM: Many glioma patients struggle to return to work after surgery because of higher brain dysfunction. Although the right frontal lobe has historically been considered functionally silent, reports of performing awake surgery to evaluate higher brain functions in patients with tumors in this area have increased. We present two cases of patients who underwent awake surgery for malignant glioma in the right frontal lobe to preserve emotional recognition and facilitate an early return to work.
Case 1 was a 48-year-old right-handed woman employed as a nursery school teacher and case 2 was a 21-year-old right-handed man employed in sales. Both had contrast-enhancing right frontal lobe tumors exhibiting high signal intensity on fluid attenuated inversion recovery imaging and underwent awake surgery. During the operation, cortical mapping was performed using the Reading the Mind in the Eyes, calculation, and motor tasks. Resection of sites involved in motor and emotional recognition functions was avoided. In case 1, all regions of high signal intensity were completely resected; in case 2, all regions exhibiting enhancement were resected. Both patients were discharged home without neurological deficits and returned to work within 21 days after surgery.
It may be important to focus not only on overall survival and progression-free survival in glioma patients, but also on factors associated with life satisfaction, such as time to return to work after surgery and time until work becomes difficult. Awake surgery aimed at preserving higher brain functions is useful and may also improve life satisfaction.
背景/目的：许多胶质瘤患者由于大脑高级功能障碍而难以在手术后重返工作岗位。尽管右额叶在历史上被认为是功能上无作用的，但有越来越多的报道称，在该区域肿瘤患者中进行清醒手术以评估高级大脑功能。我们报告了两例在右额叶接受恶性胶质瘤清醒手术以保留情感识别并促进早期重返工作岗位的患者。
病例 1 为 48 岁的右利手女性，职业为幼儿园教师；病例 2 为 21 岁的右利手男性，职业为销售。两者均有右额叶增强对比的肿瘤，FLAIR 成像显示高信号强度，并接受了清醒手术。手术中使用 Reading the Mind in the Eyes、计算和运动任务进行皮质映射。避免切除涉及运动和情感识别功能的部位。在病例 1 中，完全切除了所有高信号强度区域；在病例 2 中，切除了所有增强区域。两名患者均无神经功能缺损出院，并在术后 21 天内返回工作岗位。
对于胶质瘤患者，不仅要关注总体生存率和无进展生存率，还要关注与生活满意度相关的因素，例如手术后重返工作的时间和工作变得困难的时间。旨在保留高级大脑功能的清醒手术是有用的，也可能提高生活满意度。
