Molina-Botello Diego, Santellán-Hernández José O, Mondragon Soto Michel Gustavo, García-Bitar Andrea, Mejía-Pérez Sonia Iliana
Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MEX.
Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX.
Cureus. 2025 May 27;17(5):e84868. doi: 10.7759/cureus.84868. eCollection 2025 May.
The aim of this literature review is to summarize techniques used to prevent postoperative visual pathway complications during parietal glioma resection involving optic radiations, focusing on the use of virtual reality (VR) headsets during awake patient surgery. We searched the Medline database for literature between the years 1970 and 2024. Only results that included the use of awake craniotomy for sensory mapping were included for evaluation. The search was limited to studies published in English and humans as subjects. Only studies that reported patient groups treated with either parietal glioma surgery under general anesthesia or awake conditions were included. Articles describing deep brain stimulation as the therapy were excluded because the primary focus of this literature review is on techniques such as VR and intraoperative mapping, which aim to preserve or protect the integrity of the visual pathways during glioma resection involving the optic radiations. The variables initially selected for analysis included the length of surgery, length of hospital stay, extent of resection, cost, mortality, and neurological morbidity. Cost was later removed from the studied variables because too few studies reported it. No commentaries or reviews were included. Gliomas are the most common primary brain tumors, located mainly in the cerebral cortex. Of them, some are found in the parietal lobe, which is a convergence area for multiple stimulus integrations. After surgical resection of this lobe, patients may develop postoperative verbal, linguistic, and visual field deficits. The gold standard treatment for these tumors is surgical resection. The main technique to preserve functional pathways is by intraoperative monitoring, for which different tools have been developed in the past years. Surgeons can test and preserve important tracts, such as the visual pathway. Intraoperative ultrasound has been shown to be an excellent, accessible, and affordable intraoperative monitoring tool. Magnetic resonance imaging-based tractography and VR-based brain mapping allow not only intraoperative monitoring, but also create a preoperative plan by demarcating the structures and margins of the tumor prior to and during surgery, increasing the success rate in maximum resection.
本综述的目的是总结在涉及视辐射的顶叶胶质瘤切除术中预防术后视觉通路并发症的技术，重点关注清醒患者手术期间虚拟现实（VR）头戴设备的使用。我们在Medline数据库中检索了1970年至2024年的文献。仅纳入包括使用清醒开颅术进行感觉映射的结果进行评估。检索仅限于以英文发表且以人类为研究对象的研究。仅纳入报告了在全身麻醉或清醒条件下接受顶叶胶质瘤手术治疗的患者组的研究。描述深部脑刺激作为治疗方法的文章被排除，因为本综述的主要重点是VR和术中映射等技术，这些技术旨在在涉及视辐射的胶质瘤切除术中保留或保护视觉通路的完整性。最初选择进行分析的变量包括手术时长、住院时间、切除范围、费用、死亡率和神经功能障碍。费用后来从研究变量中剔除，因为报告该变量的研究太少。未纳入评论或综述。胶质瘤是最常见的原发性脑肿瘤，主要位于大脑皮层。其中一些位于顶叶，顶叶是多种刺激整合的汇聚区域。切除该叶后，患者可能会出现术后语言、语言和视野缺损。这些肿瘤的金标准治疗方法是手术切除。保留功能通路的主要技术是术中监测，在过去几年中已经开发了不同的工具。外科医生可以测试并保留重要的神经束，如视觉通路。术中超声已被证明是一种出色、易于使用且经济实惠的术中监测工具。基于磁共振成像的神经束成像和基于VR的脑图谱不仅可以进行术中监测，还可以通过在手术前和手术期间划定肿瘤的结构和边界来制定术前计划，提高最大切除的成功率。
