van Opijnen Mark P, Sadigh Yasmin, Dijkstra Miles E, Young Jacob S, Krieg Sandro M, Ille Sebastian, Sanai Nader, Rincon-Torroella Jordina, Maruyama Takashi, Schucht Philippe, Smith Timothy R, Nahed Brian V, Broekman Marike L D, De Vleeschouwer Steven, Berger Mitchel S, Vincent Arnaud J P E, Gerritsen Jasper K W
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurosurgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
J Neurooncol. 2025 Feb;171(3):485-493. doi: 10.1007/s11060-024-04874-1. Epub 2024 Nov 18.
Previous evidence suggests that glioma re-resection can be effective in improving clinical outcomes. Furthermore, the use of mapping techniques during surgery has proven beneficial for newly diagnosed glioma patients. However, the effects of these mapping techniques during re-resection are not clear. This systematic review aimed to assess the evidence of using these techniques for recurrent glioma patients.
A systematic search was performed to identify relevant studies. Articles were eligible if they included adult patients with recurrent gliomas (WHO grade 2-4) who underwent re-resection. Study characteristics, application of mapping, and surgical outcome data on survival, patient functioning, and complications were extracted.
The literature strategy identified 6372 articles, of which 125 were screened for eligibility. After full-text evaluation, 58 articles were included in this review, comprising 5311 patients with re-resection for glioma. Of these articles, 17% (10/58) reported the use of awake or asleep intraoperative mapping techniques during re-resection. Mapping was applied in 5% (280/5311) of all patients, and awake craniotomy was used in 3% (142/5311) of the patients.
Mapping techniques can be used during re-resection, with some evidence that it is useful to improve clinical outcomes. However, there is a lack of high-quality support in the literature for using these techniques. The low number of studies reporting mapping techniques may, next to publication bias, reflect limited application in the recurrent setting. We advocate for future studies to determine their utility in reducing morbidity and increasing extent of resection, similar to their benefits in the primary setting.
先前的证据表明，胶质瘤再次切除术可有效改善临床结局。此外，手术中使用定位技术已被证明对新诊断的胶质瘤患者有益。然而，这些定位技术在再次切除术中的效果尚不清楚。本系统评价旨在评估在复发性胶质瘤患者中使用这些技术的证据。
进行系统检索以确定相关研究。纳入的文章需包含接受再次切除术的复发性胶质瘤（世界卫生组织2-4级）成年患者。提取研究特征、定位技术的应用以及关于生存、患者功能和并发症的手术结局数据。
文献检索策略共识别出6372篇文章，其中125篇经筛选符合纳入标准。经过全文评估，本综述纳入了58篇文章，包括5311例接受胶质瘤再次切除术的患者。在这些文章中，17%（10/58）报告在再次切除术中使用了清醒或麻醉状态下的术中定位技术。所有患者中有5%（280/5311）应用了定位技术，3%（142/5311）的患者采用了清醒开颅手术。
定位技术可在再次切除术中使用，有证据表明其对改善临床结局有用。然而，文献中缺乏使用这些技术的高质量支持。报告定位技术的研究数量较少，除了发表偏倚外，可能还反映了其在复发情况下的应用有限。我们提倡未来开展研究，以确定其在降低发病率和增加切除范围方面的效用，类似于其在初次手术中的益处。
