Chang Tao, Wu Yihan, Quan Yuxin, Chen Siliang, Liao Jiawei, Zhao Wenyu, Li Yu, Fang Yuan, Zong Yixuan, Liu Yanhui, Jiang Ning, Mao Qing, He Jiayuan, Yang Yuan
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Int J Surg. 2025 Apr 1;111(4):2849-2861. doi: 10.1097/JS9.0000000000002277.
The dilemma of achieving 'onco-functional balance' in gliomas affecting the motor cortex highlights the importance of functionally-guided resection strategies. While accurate mapping of eloquent areas often requires frequent electrical stimulation, this practice can lead to side effects like seizures and postoperative deficits. To enhance safety in functional mapping, we studied how gliomas impact hand movement areas and assessed the effectiveness of cortical electrical activity for functional mapping in this setting.
We recruited patients with gliomas affecting the motor cortex and individuals with an unaffected motor cortex for awake craniotomy. During the procedures, electrocorticography (ECoG) grids were employed to record signals under three conditions: resting state, finger movements, and wrist movements. We then quantified the distances from the positively stimulated sites to the specific anatomical landmarks. Additionally, we analyzed the relationship between the ECoG power features and the stimulation responses.
The cortical layout for finger activity in the motor cortex glioma (MCG) group was more dispersed and overlapped, typically clustering near the central sulcus and Sylvian fissure. The predictive performance of ECoG mapping exhibited significant variability across different frequency bands and clinical scenarios. Specifically, the area under the curve (AUC) for the non-MCG group during the resting state reached its peak, with a value of 0.802 for Gamma3 (95% CI = 0.729-0.875) and 0.865 for broadband (95% CI = 0.804-0.926). In contrast, the MCG group achieved the highest AUC during wrist movements, with Gamma3 at 0.785 (95% CI = 0.719-0.849) and broadband at 0.824 (95% CI = 0.753-0.890).
Gliomas in the motor cortex disrupt the distribution of hand activity, complicating intraoperative functional mapping. As a novel and reliable approach, ECoG technique can complement and guide direct cortical stimulation for precise mapping, potentially reducing its frequency, minimizing the risk of functional deficits, and achieving a balance between maximal tumor resection and neurological preservation.
在影响运动皮层的胶质瘤中实现“肿瘤功能平衡”的困境凸显了功能导向性切除策略的重要性。虽然明确区域的精确映射通常需要频繁的电刺激，但这种做法可能会导致癫痫发作和术后功能缺陷等副作用。为了提高功能映射的安全性，我们研究了胶质瘤如何影响手部运动区域，并评估了皮质电活动在这种情况下进行功能映射的有效性。
我们招募了患有影响运动皮层的胶质瘤患者以及运动皮层未受影响的个体进行清醒开颅手术。在手术过程中，使用皮质脑电图（ECoG）网格在三种情况下记录信号：静息状态、手指运动和腕部运动。然后，我们量化了正向刺激部位到特定解剖标志的距离。此外，我们分析了ECoG功率特征与刺激反应之间的关系。
运动皮层胶质瘤（MCG）组中手指活动的皮质布局更加分散且重叠，通常聚集在中央沟和外侧裂附近。ECoG映射的预测性能在不同频段和临床场景中表现出显著差异。具体而言，非MCG组在静息状态下的曲线下面积（AUC）达到峰值，Gamma3频段为0.802（95%置信区间=0.729-0.875），宽带为0.865（95%置信区间=0.804-0.926）。相比之下，MCG组在腕部运动时AUC最高，Gamma3频段为0.785（95%置信区间=0.719-0.849），宽带为0.824（95%置信区间=0.753-0.890）。
运动皮层的胶质瘤会破坏手部活动的分布，使术中功能映射变得复杂。作为一种新颖且可靠的方法，ECoG技术可以补充并指导直接皮质刺激以进行精确映射，可能会减少其频率，将功能缺陷风险降至最低，并在最大程度切除肿瘤和保留神经功能之间实现平衡。
