{"title":"额叶旁脉结构的肿瘤切除有发生胼胝体梗死的风险","authors":"Yoshiteru Shimoda, Masayuki Kanamori, Shinichiro Osawa, Shingo Kayano, Ryuta Saito, Mugikura Shunji, Tominaga Teiji, Hidenori Endo","doi":"10.1007/s00701-025-06555-y","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>Surgeons resecting intraparenchymal tumors should be aware of potential white matter ischemia resulting from damage to the medullary artery arising from the cerebral cortex. In the vicinity of the paramedian structure, crucial brain regions for higher brain function such as corpus callosum and cingulate cortex are located. However, the actual area of ischemia induced by damaging the medullary artery supplying the paramedian structures is not known. The present study investigated the ischemic field following tumor resection in paramedian structures of the frontal lobe.</p><h3>methods</h3><p>Patients having intraparenchymal tumors with lesions in the paramedian structures of the frontal lobe (superior frontal gyrus or cingulate gyrus) resected between April 2016 and June 2022 at Tohoku University Hospital were included in the study. Magnetic resonance images obtained within 72 h after surgery were used to retrospectively examine the extent of the resection and the distribution of ischemic complications. Related postoperative clinical symptoms were assessed using medical records.</p><h3>Results</h3><p>Thirty-three cases matched the inclusion criteria. The median age was 48 years. Cases comprised patients with an astrocytoma IDH-mutant (<i>n</i> = 11), oligodendroglioma IDH-mutant, and 1p/19q-codeletion (<i>n</i> = 12), and glioblastoma IDH-wildtype (<i>n</i> = 10). The main locations were superior frontal gyrus only (<i>n</i> = 17), cingulate gyrus only (<i>n</i> = 8), and both the frontal lobe and cingulate gyrus (<i>n</i> = 8). The cingulate gyrus was removed in 19 cases. In 16 of the 19 cases, ischemic foci were observed in the adjacent corpus callosum. In the 14 cases in which the cingulate gyrus was not removed, no ischemic foci appeared in the corpus callosum. Three cases exhibited a prolonged disturbance of consciousness after the second postoperative day, all with corpus callosum infarction.</p><h3>Conclusion</h3><p>Surgeons resecting intraparenchymal tumors in the paramedian structures of the frontal lobe, especially the cingulate gyrus, should be aware of the potential for ischemia foci emerging in the corpus callosum.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06555-y.pdf","citationCount":"0","resultStr":"{\"title\":\"Tumor resection in paramedian structures of the frontal lobe poses a risk for corpus callosum infarction\",\"authors\":\"Yoshiteru Shimoda, Masayuki Kanamori, Shinichiro Osawa, Shingo Kayano, Ryuta Saito, Mugikura Shunji, Tominaga Teiji, Hidenori Endo\",\"doi\":\"10.1007/s00701-025-06555-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>Surgeons resecting intraparenchymal tumors should be aware of potential white matter ischemia resulting from damage to the medullary artery arising from the cerebral cortex. In the vicinity of the paramedian structure, crucial brain regions for higher brain function such as corpus callosum and cingulate cortex are located. However, the actual area of ischemia induced by damaging the medullary artery supplying the paramedian structures is not known. The present study investigated the ischemic field following tumor resection in paramedian structures of the frontal lobe.</p><h3>methods</h3><p>Patients having intraparenchymal tumors with lesions in the paramedian structures of the frontal lobe (superior frontal gyrus or cingulate gyrus) resected between April 2016 and June 2022 at Tohoku University Hospital were included in the study. Magnetic resonance images obtained within 72 h after surgery were used to retrospectively examine the extent of the resection and the distribution of ischemic complications. Related postoperative clinical symptoms were assessed using medical records.</p><h3>Results</h3><p>Thirty-three cases matched the inclusion criteria. The median age was 48 years. Cases comprised patients with an astrocytoma IDH-mutant (<i>n</i> = 11), oligodendroglioma IDH-mutant, and 1p/19q-codeletion (<i>n</i> = 12), and glioblastoma IDH-wildtype (<i>n</i> = 10). The main locations were superior frontal gyrus only (<i>n</i> = 17), cingulate gyrus only (<i>n</i> = 8), and both the frontal lobe and cingulate gyrus (<i>n</i> = 8). The cingulate gyrus was removed in 19 cases. In 16 of the 19 cases, ischemic foci were observed in the adjacent corpus callosum. In the 14 cases in which the cingulate gyrus was not removed, no ischemic foci appeared in the corpus callosum. Three cases exhibited a prolonged disturbance of consciousness after the second postoperative day, all with corpus callosum infarction.</p><h3>Conclusion</h3><p>Surgeons resecting intraparenchymal tumors in the paramedian structures of the frontal lobe, especially the cingulate gyrus, should be aware of the potential for ischemia foci emerging in the corpus callosum.</p></div>\",\"PeriodicalId\":7370,\"journal\":{\"name\":\"Acta Neurochirurgica\",\"volume\":\"167 1\",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-05-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://link.springer.com/content/pdf/10.1007/s00701-025-06555-y.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Neurochirurgica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://link.springer.com/article/10.1007/s00701-025-06555-y\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurochirurgica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00701-025-06555-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Tumor resection in paramedian structures of the frontal lobe poses a risk for corpus callosum infarction
Purpose
Surgeons resecting intraparenchymal tumors should be aware of potential white matter ischemia resulting from damage to the medullary artery arising from the cerebral cortex. In the vicinity of the paramedian structure, crucial brain regions for higher brain function such as corpus callosum and cingulate cortex are located. However, the actual area of ischemia induced by damaging the medullary artery supplying the paramedian structures is not known. The present study investigated the ischemic field following tumor resection in paramedian structures of the frontal lobe.
methods
Patients having intraparenchymal tumors with lesions in the paramedian structures of the frontal lobe (superior frontal gyrus or cingulate gyrus) resected between April 2016 and June 2022 at Tohoku University Hospital were included in the study. Magnetic resonance images obtained within 72 h after surgery were used to retrospectively examine the extent of the resection and the distribution of ischemic complications. Related postoperative clinical symptoms were assessed using medical records.
Results
Thirty-three cases matched the inclusion criteria. The median age was 48 years. Cases comprised patients with an astrocytoma IDH-mutant (n = 11), oligodendroglioma IDH-mutant, and 1p/19q-codeletion (n = 12), and glioblastoma IDH-wildtype (n = 10). The main locations were superior frontal gyrus only (n = 17), cingulate gyrus only (n = 8), and both the frontal lobe and cingulate gyrus (n = 8). The cingulate gyrus was removed in 19 cases. In 16 of the 19 cases, ischemic foci were observed in the adjacent corpus callosum. In the 14 cases in which the cingulate gyrus was not removed, no ischemic foci appeared in the corpus callosum. Three cases exhibited a prolonged disturbance of consciousness after the second postoperative day, all with corpus callosum infarction.
Conclusion
Surgeons resecting intraparenchymal tumors in the paramedian structures of the frontal lobe, especially the cingulate gyrus, should be aware of the potential for ischemia foci emerging in the corpus callosum.
期刊介绍：
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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