Donaldson Hayley, Golub Danielle, Placantonakis Dimitris G
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Neurosurgery, Northwell Health, Manhasset, New York.
J Neurosurg Case Lessons. 2024 Oct 14;8(16). doi: 10.3171/CASE24362.
Resection of glioblastoma (GBM) in eloquent regions depends on functional mapping to limit perioperative neurological morbidity. When neurological deficits preclude reliable mapping, neurosurgeons should explore potential mitigation strategies. The authors present the case of a patient with a large left cystic temporoinsular GBM and aphasia, for whom the authors used intraoperative language mapping and a staged approach to enable safe tumor resection.
A 49-year-old female presented with progressive mixed aphasia for 1 month and new-onset right facial droop. Magnetic resonance imaging (MRI) revealed a large, heterogeneously enhancing, left temporoinsular tumor with a significant cystic component. Her aphasia was profound, and resection without reliable language mapping was deemed unsafe. An initial stereotactic tumoral cyst aspiration was performed, which reduced local mass effect and improved her language function. Cyst decompression thereby enabled both task-based functional MRI and intraoperative awake speech mapping, resulting in a safe resection of her GBM.
Safe resection of eloquently localized GBM is compromised when neurological deficits prohibit intraoperative functional mapping. This case demonstrates a mitigation strategy specific to cystic lesions in which an initial-stage stereotactic cyst aspiration is aimed at generating sufficient interval neurological improvement, such that intraoperative functional mapping can be performed during a second-stage resection. https://thejns.org/doi/10.3171/CASE24362.
位于功能区的胶质母细胞瘤（GBM）切除术依赖功能图谱来限制围手术期神经功能损伤。当神经功能缺损妨碍进行可靠的图谱绘制时，神经外科医生应探索潜在的缓解策略。作者报告了1例左侧颞岛叶巨大囊性GBM伴失语症患者的病例，作者采用术中语言图谱和分期手术方法实现了安全的肿瘤切除。
1例49岁女性，渐进性混合性失语1个月，新发右侧面部下垂。磁共振成像（MRI）显示左侧颞岛叶有一个巨大的、不均匀强化的肿瘤，伴有明显的囊性成分。她的失语症严重，在没有可靠语言图谱的情况下进行切除被认为不安全。最初进行了立体定向肿瘤囊肿抽吸术，减轻了局部占位效应并改善了她的语言功能。囊肿减压从而使基于任务的功能MRI和术中清醒言语图谱检查成为可能，最终安全切除了她的GBM。
当神经功能缺损妨碍术中功能图谱绘制时，位于功能区的GBM的安全切除会受到影响。本病例展示了一种针对囊性病变的缓解策略，即第一阶段进行立体定向囊肿抽吸术，目的是实现足够的神经功能改善，以便在第二阶段切除术中进行术中功能图谱绘制。https://thejns.org/doi/10.3171/CASE24362 。
