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双侧前扣带回胶质母细胞瘤切除术后的术后意志缺失:一例报告及经验教训

Postoperative Abulia Following Resection of Bilateral Anterior Cingulate Gyrus Glioblastoma: A Case Report and Lessons Learned.

作者信息

Sugii Narushi, Tamura Goichiro, Ishikawa Eiichi

机构信息

Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.

Department of Neurosurgery, Mito Saiseikai General Hospital, Mito, JPN.

出版信息

Cureus. 2025 Jul 8;17(7):e87547. doi: 10.7759/cureus.87547. eCollection 2025 Jul.


DOI:10.7759/cureus.87547
PMID:40786312
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12333896/
Abstract

Glioblastoma is a highly malignant brain tumor with a dismal prognosis that requires multidisciplinary treatment, emphasizing 'maximal safe resection' during surgery. Neurosurgeons often rely on empirical knowledge, which suggests that removing only contrast-enhancing lesions should not cause new neurological deficits. However, we encountered a case in which this assumption did not hold true. A 60-year-old, right-handed man presented with declining frontal lobe function and a large mass involving the bilateral anterior cingulate gyrus (ACG) and left superior frontal gyrus (SFG). After initial removal of the left SFG tumor, the patient showed no new deficits. The pathological diagnosis confirmed glioblastoma, IDH-wildtype. A second surgery was performed to resect the remaining contrast-enhancing lesions involving the bilateral dorsal anterior cingulate cortex (dACC), via the initial surgical corridor. Postoperatively, the patient developed persistent abulia. This case highlights a critical exception to prevailing surgical dogma. Although the resection targeted only contrast-enhancing tissue, the involvement of the bilateral dACC, a key node of the salience network, likely led to severe cognitive and motivational dysfunction. Greater attention to functional neuroanatomy may be necessary to optimize outcomes in complex glioblastoma cases, even within contrast-enhancing tumor regions.

摘要

胶质母细胞瘤是一种高度恶性的脑肿瘤,预后很差,需要多学科治疗,手术时强调“最大安全切除”。神经外科医生通常依靠经验知识,即仅切除强化病变不应导致新的神经功能缺损。然而,我们遇到了一个该假设不成立的病例。一名60岁右利手男性,出现额叶功能减退,有一个累及双侧前扣带回(ACG)和左侧额上回(SFG)的大肿块。在最初切除左侧SFG肿瘤后,患者未出现新的功能缺损。病理诊断为胶质母细胞瘤,异柠檬酸脱氢酶(IDH)野生型。通过最初的手术通道进行了第二次手术,以切除累及双侧背侧前扣带回皮质(dACC)的其余强化病变。术后,患者出现持续性意志缺失。该病例凸显了当前手术教条的一个关键例外情况。尽管切除仅针对强化组织,但双侧dACC作为突显网络的关键节点受累,可能导致了严重的认知和动机功能障碍。即使在强化肿瘤区域内,对于复杂的胶质母细胞瘤病例,可能也需要更加关注功能性神经解剖结构以优化治疗结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/b1bf38120814/cureus-0017-00000087547-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/580fb12b1ade/cureus-0017-00000087547-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/14f02e510319/cureus-0017-00000087547-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/b1bf38120814/cureus-0017-00000087547-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/580fb12b1ade/cureus-0017-00000087547-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/14f02e510319/cureus-0017-00000087547-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21dc/12333896/b1bf38120814/cureus-0017-00000087547-i03.jpg

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本文引用的文献

[1]
Tumor-Associated Tractography Derived from High-Angular-Resolution Q-Space MRI May Predict Patterns of Cellular Invasion in Glioblastoma.

Cancers (Basel). 2024-10-30

[2]
Prognostic significance of MRI contrast enhancement in newly diagnosed glioblastoma, IDH-wildtype according to WHO 2021 classification.

J Neurooncol. 2024-9

[3]
Tumour-infiltrated cortex participates in large-scale cognitive circuits.

Cortex. 2024-4

[4]
Glioblastoma remodelling of human neural circuits decreases survival.

Nature. 2023-5

[5]
The role of the salience network in cognitive and affective deficits.

Front Hum Neurosci. 2023-3-20

[6]
Impact of maximal extent of resection on postoperative deficits, patient functioning, and survival within clinically important glioblastoma subgroups.

Neuro Oncol. 2023-5-4

[7]
Front and center: Maturational dysregulation of frontal lobe functional neuroanatomic connections in attention deficit hyperactivity disorder.

Front Neuroanat. 2022-8-23

[8]
Maximum resection and immunotherapy improve glioblastoma patient survival: a retrospective single-institution prognostic analysis.

BMC Neurol. 2021-7-19

[9]
Full recovery of Akinetic Mutism after corpus callosum infarction in post subarachnoid hemorrhage of ruptured distal anterior cerebral artery aneurysm.

Neurosciences (Riyadh). 2020-10

[10]
Prognostic relevance of adding MRI data to WHO 2016 and cIMPACT-NOW updates for diffuse astrocytic tumors in adults. Working toward the extended use of MRI data in integrated glioma diagnosis.

Brain Pathol. 2021-7

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