Rammeloo Emma, Young Jacob S, Schouten Joost W, Bos Eelke M, Hervey-Jumper Shawn L, Jungk Christine, Krieg Sandro M, Smith Timothy, Rincon-Torroella Jordina, Bettegowda Chetan, Maruyama Takashi, Wagner Arthur, Schucht Philippe, Broekman Marike L D, De Vleeschouwer Steven, Nahed Brian V, Berger Mitchel S, Vincent Arnaud J P E, Gerritsen Jasper K W
Department of Neurosurgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Department of Neurosurgery, University of California, San Francisco, CA, USA.
J Neurooncol. 2025 May 21. doi: 10.1007/s11060-025-05067-0.
BACKGROUND AND OBJECTIVES: Tumor location and its proximity to eloquent brain areas are key factors in glioma surgery decision-making. However, the absence of a consensus definition for eloquent brain areas leads to variability in surgical decision-making. This survey aimed to assess this heterogeneity in defining eloquent brain regions. METHODS: A survey was distributed among neurosurgeons in the United States, Europe, Latin America, and Australasia between February and November 2023. Respondents rated the eloquence of various brain structures on a Likert scale and reported their use of preoperative techniques. Twelve glioma and glioblastoma cases were presented to assess opinions on tumor location eloquence and preferred surgical approaches. RESULTS: 157 neurosurgeons from 25 countries responded to the survey. Two-thirds (68%) agreed on the need for a standardized definition of eloquence, while only 23% applied existing eloquence grading scales. Eloquence ratings varied, with the highest variation reported for the corona radiata, uncinate fasciculus and superior longitudinal fasciculus. In patient cases, variability was observed at four levels of decision-making: (1) degree of eloquence; (2) preferred surgical modality; (3) use of intraoperative mapping; (4) the preferred mapping modality (asleep or awake). CONCLUSIONS: This survey highlights the variability in defining eloquence and its impact on glioma surgery decision-making. This lack of consensus limits the reliability of eloquence as a descriptor of tumor location, affecting patient care and comparability across studies. Future research should focus on the development of an easy-to-use, objective method (based on intraoperative data) for identifying eloquent brain regions preoperatively.
背景与目的:肿瘤位置及其与脑功能区的接近程度是胶质瘤手术决策的关键因素。然而,脑功能区缺乏共识性定义导致手术决策存在差异。本调查旨在评估在定义脑功能区方面的这种异质性。 方法:2023年2月至11月期间,在美国、欧洲、拉丁美洲和澳大拉西亚的神经外科医生中开展了一项调查。受访者用李克特量表对各种脑结构的功能进行评分,并报告他们对术前技术的使用情况。展示了12例胶质瘤和胶质母细胞瘤病例,以评估对肿瘤位置功能及首选手术方法的看法。 结果:来自25个国家的157名神经外科医生回复了调查。三分之二(68%)的人同意需要对功能进行标准化定义,而只有23%的人应用现有的功能分级量表。功能评分各不相同,放射冠、钩束和上纵束的评分差异最大。在患者病例中,在四个决策层面观察到了差异:(1)功能程度;(2)首选手术方式;(3)术中图谱的使用;(4)首选的图谱方式(睡眠或清醒)。 结论:本调查突出了在定义功能方面的差异及其对胶质瘤手术决策的影响。这种缺乏共识限制了功能作为肿瘤位置描述符的可靠性,影响患者护理及各项研究之间的可比性。未来的研究应侧重于开发一种易于使用的、基于术中数据的客观方法,用于术前识别脑功能区。
J Neurooncol. 2025-5-21
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J Neurooncol. 2023-12