清醒手术治疗复发性胶质母细胞瘤的结果：一项单机构回顾性分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-04-01 Epub Date: 2025-02-13 DOI:10.1016/j.jocn.2025.111113

Sho Osawa , Daisuke Kawauchi , Makoto Ohno , Yasuji Miyakita , Masamichi Takahashi , Shunsuke Yanagisawa , Shohei Fujita , Takahiro Tsuchiya , Junya Matsumi , Tetsufumi Sato , Yoshitaka Narita

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引用次数: 0

摘要

背景：清醒手术有助于最大限度地安全切除胶质瘤病例的脑组织，但其对复发性胶质母细胞瘤（GBM）的有效性仍未确定。在这项研究中，我们探讨了清醒手术治疗复发性GBM的安全性、成功率和手术结果。方法本研究纳入2010年3月至2023年2月在我院行清醒手术的胶质瘤病例，符合以下标准：(1)病理诊断为胶质母细胞瘤或星形细胞瘤，异柠檬酸脱氢酶突变，复发时WHO分级为4级；(2)治疗过程中第二次手术。我们回顾性分析了临床特征、作图反应、切除率、术后并发症、总生存期（OS）和无进展生存期（PFS）。结果共分析41例。中位年龄47岁，男性24例（58.5%）。35例（85.4%）成功完成清醒定位。20例（48.8%）对定位有积极反应，15例（36.6%）限制了切除。切除范围为：大体全切除20例（48.8%），次全切除11例（26.8%），部分切除8例（19.5%），活检2例（4.9%）。10例（24.4%）出现急性期神经功能缺损，2例（4.9%）出现后遗症或症状加重。复发后中位OS和PFS分别为18.7个月和7.2个月。结论唤醒定位治疗复发性GBM并发症发生率低，有利于肿瘤切除，且不加重神经系统症状。清醒手术治疗复发性GBM可能有助于延长生存期。

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Outcomes of awake surgery for recurrent glioblastoma: A single-institution retrospective analysis

Background

Awake surgery facilitates maximal safe resection of brain tissue in cases of glioma, but its effectiveness for recurrent glioblastoma (GBM) remains unestablished. In this study, we investigate the safety, success rate of mapping, and surgical outcomes of awake surgery for recurrent GBM.

Methods

This study included glioma cases that underwent awake surgery at our hospital between March 2010 and February 2023 and met the following criteria: (1) cases with a pathologic diagnosis of glioblastoma or astrocytoma, isocitrate dehydrogenase-mutant, WHO grade 4 at recurrence, and (2) cases in which this was the second surgery in the course of treatment. We retrospectively analyzed the clinical features, mapping response, resection rate, postoperative complications, overall survival (OS), and progression-free survival (PFS).

Results

Forty-one cases were analyzed. The median age was 47 years, and 24 patients (58.5 %) were male. Awake mapping was successfully completed in 35 cases (85.4 %). A positive response to mapping was observed in 20 cases (48.8 %), which limited resection in 15 cases (36.6 %). The extent of resection was gross total resection in 20 cases (48.8 %), subtotal resection in 11 cases (26.8 %), partial resection in 8 cases (19.5 %), and biopsy in 2 cases (4.9 %). Acute-phase neurological deficits developed in 10 cases (24.4 %), but sequelae or symptom exacerbations were observed in 2 cases (4.9 %). The median post-recurrence OS and PFS were 18.7 months and 7.2 months, respectively.

Conclusions

Awake mapping for recurrent GBM demonstrated a low complication rate and facilitated tumor resection without exacerbating neurological symptoms. Awake surgery for recurrent GBM may contribute to prolonged survival.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.