后窝肿瘤手术儿童术后语言障碍和颅神经缺损的术中MRI -一项前瞻性多国研究

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-09-22 DOI:10.1007/s00701-025-06669-3

Aske Foldbjerg Laustsen, Jonathan Kjær Grønbæk, Radek Frič, Shivaram Avula, Conor Mallucci, Pelle Nilsson, Per Nyman, Péter Hauser, Katalin Mudra, Rosita Kiudeliene, Saulius Ročka, Magnus Aasved Hjort, Rick Brandsma, Eelco Hoving, Andrea Carai, Vladimír Beneš, Jana Táborská, Christian Dorfer, Sandra Jacobs, Miriam Pavon-Mengual, Jane Skjøth-Rasmussen, Kjeld Schmiegelow, Astrid Sehested, René Mathiasen, Marianne Juhler

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引用次数: 0

摘要

背景术后语言障碍（POSI）和颅神经缺损（CND）是儿童后窝（PF）肿瘤手术的常见并发症。术中MRI （ioMRI）已被证明是实现大体全切除的有用工具。ioMRI的POSI和CND风险尚不清楚，因此是本研究的主要范围。此外，我们评估了POSI是否与CND相关。方法我们前瞻性地纳入了15个欧洲国家36个中心接受PF肿瘤手术的儿童患者。术前及术后1-4周分别评估神经功能和语言功能。手术细节，包括肿瘤位置和ioMRI的使用，在手术后72小时内记录。术后CND分为受影响神经0、1、2或≥3条；习惯性的、言语减少的或缄默症。比例优势模型估计了1)POSI与肿瘤位置和年龄逐步调整的比值比（OR），以及2)CND与术前CND和肿瘤位置调整的比值比（OR）。亚组分析评估了系统差异、缺失数据、中心水平效应和组织学调整。结果790例原发性PF肿瘤手术中，141例（18%）涉及ioMRI。POSI发生在183/790(23%)，术后CND发生在213/790（27%）。ioMRI阳性风险未调整OR (95% CI) 0.83 (0.53;1.30)；调整OR 0.76（0.43;1.35）。ioMRI观察到的CNDs较少(未校正OR 0.63（0.40;1.00)，校正OR 0.58 (0.33;0.94), p = 0.03）。阳性风险与更多的心血管疾病相关(1个心血管疾病的调整OR: 2.06 (1.15;3.68)；2和d: 2.13 (1.02;4.42)；≥3 CND: 4.15 (1.98;8.70), p < 0.05)。结论：在这个多中心队列中，omri与术后并发症风险增加无关。ioMRI病例中CND的减少可能反映了对手术决策、专业知识、病例负荷和病例组合的衍生影响。由于术中资料有限，结果应谨慎解释。posio风险与累积性CND之间的关联可能表明脑干广泛受累。我们的研究结果强调需要进一步探索iomri指导策略如何影响儿童PF肿瘤手术的功能结局。临床试验IDNCT02300766（2014年10月）

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Postoperative speech impairment and cranial nerve deficits in children undergoing posterior fossa tumor surgery with intraoperative MRI – a prospective multinational study

Background

Postoperative speech impairment (POSI) and cranial nerve deficits (CND) are common complications of pediatric posterior fossa (PF) tumor surgery. Intraoperative MRI (ioMRI) has proven a useful tool in achieving gross total resection. The risk of POSI and CND with ioMRI remains unclear, making it the primary scope of this study. Additionally, we assessed whether POSI was associated with CND.

Methods

We prospectively included pediatric patients undergoing PF tumor surgery in 36 centers across 15 European countries. Neurological status and speech were assessed preoperatively and 1–4 weeks postoperatively. Surgical details, including tumor location and use of ioMRI, were recorded within 72 h of surgery. Postoperative CND were categorized as 0, 1, 2, or ≥ 3 nerves affected; POSI as habitual, reduced speech, or mutism. Proportional odds models estimated odds ratios (OR) for 1) POSI with stepwise adjustment for tumor location and age, and 2) CND with adjustment for preoperative CND and tumor location. Subgroup analyses assessed systematic differences, missing data, center-level effects, and histology adjustment.

Results

Of 790 primary PF tumor surgeries, 141 (18%) involved ioMRI. POSI occurred in 183/790 (23%) and postoperative CND in 213/790 (27%). POSI-risk with ioMRI showed non-significant unadjusted OR (95% CI) 0.83 (0.53;1.30); adjusted OR 0.76 (0.43;1.35). Fewer CNDs were observed with ioMRI (unadjusted OR 0.63 (0.40;1.00), adjusted OR 0.58 (0.33;0.94), p = 0.03). POSI-risk was associated with more CNDs (adjusted OR for 1 CND: 2.06 (1.15;3.68); 2 CND: 2.13 (1.02;4.42); ≥ 3 CND: 4.15 (1.98;8.70), p < 0.05).

Conclusions

ioMRI was not associated with increased risk of postoperative complications in this multicenter cohort. The reduction in CND among ioMRI cases may reflect derived effects on surgical decision-making, expertise, case-load and case-mix. Results should be interpreted with caution due to limited intraoperative data. The association between POSI-risk and cumulative CND may indicate extensive brainstem involvement. Our findings highlight the need to further explore how ioMRI-guided strategies affect functional outcomes in pediatric PF tumour surgery.

Clinical Trials ID

NCT02300766 (October 2014)

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

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.