BACKGROUND: The resection of brain tumors can be critical concerning localization, but is a key point in treating gliomas. Intraoperative neuromonitoring (IONM), awake craniotomy, and mapping procedures have been incorporated over the years. Using these intraoperative techniques, the resection of eloquent-area tumors without increasing postoperative morbidity became possible. This study aims to analyze short-term and particularly long-term outcomes in patients diagnosed with high-grade glioma, who underwent surgical resection under various technical intraoperative settings over 14 years. METHODS: A total of 1010 patients with high-grade glioma that underwent resection between 2004 and 2018 under different monitoring or mapping procedures were screened; 631 were considered eligible for further analyses. We analyzed the type of surgery (resection vs. biopsy) and type of IONM or mapping procedures that were performed. Furthermore, the impact on short-term (The National Institute of Health Stroke Scale, NIHSS; Karnofsky Performance Scale, KPS) and long-term (progression-free survival, PFS; overall survival, OS) outcomes was analyzed. Additionally, the localization, extent of resection (EOR), residual tumor volume (RTV), IDH status, and adjuvant therapy were approached. RESULTS: In 481 patients, surgery, and in 150, biopsies were performed. The number of biopsies decreased significantly with the incorporation of awake surgeries with bipolar stimulation, IONM, and/or monopolar mapping (p< 0.001). PFS and OS were not significantly influenced by any intraoperative technical setting. EOR and RTV achieved under different operative techniques showed no statistical significance (p= 0.404 EOR,p= 0.186 RTV). CONCLUSION: Based on the present analysis using data from 14 years and more than 600 patients, we observed that through the implementation of various monitoring and mapping techniques, a significant decrease in biopsies and an increase in the resection of eloquent tumors was achieved. With that, the operability of eloquent tumors without a negative influence on neurological outcomes is suggested by our data. However, a statistical effect of monitoring and mapping procedures on long-term outcomes such as PFS and OS could not be shown.
背景：脑肿瘤切除术的定位至关重要，是治疗胶质瘤的关键环节。多年来，术中神经监测、清醒开颅术及脑功能定位技术已逐步应用于临床。借助这些术中技术，在不增加术后并发症的前提下切除功能区肿瘤已成为可能。本研究旨在分析14年间经不同术中技术实施手术切除的高级别胶质瘤患者的短期及长期预后。方法：筛选2004年至2018年间接受不同监测或定位技术切除手术的1010例高级别胶质瘤患者，其中631例符合进一步分析条件。我们分析了手术类型（切除与活检）及术中神经监测或定位技术的应用情况，并评估其对短期预后（美国国立卫生研究院卒中量表评分、卡氏功能状态评分）和长期预后（无进展生存期、总生存期）的影响，同时考察肿瘤定位、切除范围、残余肿瘤体积、异柠檬酸脱氢酶状态及辅助治疗情况。结果：481例患者接受切除手术，150例接受活检手术。随着双极刺激清醒手术、术中神经监测和/或单极定位技术的应用，活检手术数量显著减少（p<0.001）。不同术中技术对无进展生存期和总生存期均无显著影响。不同手术技术实现的切除范围和残余肿瘤体积无统计学差异（切除范围p=0.404，残余肿瘤体积p=0.186）。结论：基于14年超过600例患者的分析数据，我们发现通过应用多种监测与定位技术，活检手术显著减少，功能区肿瘤切除率明显提升。数据显示，在不影响神经功能预后的前提下，功能区肿瘤的手术可行性得到证实。然而，监测与定位技术对无进展生存期和总生存期等长期预后指标未显示出统计学意义上的显著影响。
肿瘤(癌症)患者之家