Alkassm Emad, Grote Alexander, Berger Björn, Woermann Friedrich G, Ersoy Tunc Faik, Coras Roland, Kalbhenn Thilo, Simon Matthias
Department of Neurosurgery, Evangelisches Klinikum Bethel, Universitätsklinikum Ostwestfalen-Lippe, Bielefeld, Germany.
Department of Neuroradiology, Evangelisches Klinikum Bethel, Universitätsklinikum Ostwestfalen-Lippe, Bielefeld, Germany.
Front Neurol. 2024 Oct 15;15:1450027. doi: 10.3389/fneur.2024.1450027. eCollection 2024.
Tumors in the temporo-mesial region often extend into the insula and vice versa. The present study investigated the results of a surgical strategy that combines principles of tumor and epilepsy surgery.
We retrospectively analyzed 157 consecutive patients with intrinsic brain tumors in the temporo-mesial region, with varying degrees of extensions into the insula (44 patients, 28.0%). The surgical strategy utilized "anatomy-guided resection," targeting specific anatomical compartments infiltrated by the tumor (e.g., temporal pole, anterior temporo-mesial region = uncus and hippocampal head, posterior temporo-mesial, insula) rather than treating the tumor as a single mass.
The most frequent histologies were ganglioglioma CNS WHO grade 1 (55 patients, 35.0%) and IDH1 wildtype glioblastoma (36 patients, 22.9%). Tumor infiltration was most commonly found in the anterior temporo-mesial compartment (145 patients, 92.4%). An anterior temporal lobectomy was part of the surgical strategy in 131 cases (83.4%). Seventy-six patients (48.4%) with drug-resistant epilepsy underwent a formal presurgical epilepsy work-up, including depth electrode placement in three cases. Complete resections were achieved in 117 patients (74.5%), with supramarginal resections performed in 89 cases (56.7%). Four patients experienced non-temporary neurological complications (CTCAE grade 3-5). At 6 months, 127 of 147 assessable patients (86.4%) were free from seizures or auras (ILAE class 1), excluding early postoperative seizures (<30 days). At 24 months, 122 of 144 assessable cases (84.7%) remained seizure-free (ILAE class 1). Kaplan-Meier estimates for 5-year overall survival were 98.5% for non-recurrent glioneuronal tumors. The 2-year overall survival estimates were 96.0% for 24 primary diffuse CNS WHO grade 2 and 3 gliomas and 55.2% for 30 patients undergoing first surgeries for glioblastomas/astrocytomas CNS WHO grade 4.
Combining both epilepsy and tumor surgery concepts in the surgical treatment of intrinsic brain tumors involving the mesial temporal lobe, often extending into the insula, led to more extensive resections, improved seizure outcomes, and potentially even better patient survival outcomes.
颞叶内侧区域的肿瘤常延伸至岛叶，反之亦然。本研究探讨了一种结合肿瘤手术和癫痫手术原则的手术策略的效果。
我们回顾性分析了157例连续的颞叶内侧区域原发性脑肿瘤患者，这些肿瘤不同程度地延伸至岛叶（44例，28.0%）。手术策略采用“解剖学引导切除术”，针对肿瘤浸润的特定解剖区域（如颞极、颞叶内侧前部区域=钩回和海马头部、颞叶内侧后部、岛叶），而不是将肿瘤视为一个整体进行治疗。
最常见的组织学类型是中枢神经系统WHO 1级神经节胶质瘤（55例，35.0%）和异柠檬酸脱氢酶1（IDH1）野生型胶质母细胞瘤（36例，22.9%）。肿瘤浸润最常见于颞叶内侧前部区域（145例，92.4%）。131例（83.4%）患者的手术策略包括颞叶前部切除术。76例（48.4%）耐药性癫痫患者接受了正式的术前癫痫评估，其中3例进行了深部电极植入。117例（74.5%）患者实现了完全切除，89例（56.7%）进行了扩大切除。4例患者出现非暂时性神经并发症（CTCAE 3-5级）。在术后6个月时，147例可评估患者中有127例（86.4%）无癫痫发作或先兆（国际抗癫痫联盟1级），不包括术后早期发作（<30天）。在术后24个月时，144例可评估病例中有122例（84.7%）仍无癫痫发作（国际抗癫痫联盟1级）。非复发性神经胶质神经元肿瘤的5年总生存率的Kaplan-Meier估计值为98.5%。24例原发性弥漫性中枢神经系统WHO 2级和3级胶质瘤的2年总生存率估计值为96.0%，30例接受首次手术治疗的中枢神经系统WHO 4级胶质母细胞瘤/星形细胞瘤患者的2年总生存率估计值为55.2%。
在涉及颞叶内侧且常延伸至岛叶的原发性脑肿瘤的手术治疗中，结合癫痫手术和肿瘤手术的概念可实现更广泛的切除，改善癫痫发作结局，甚至可能带来更好的患者生存结局。
