Awake surgery contributes to the maximal safe removal of gliomas by localizing brain function. However, the efficacy and safety thereof as a treatment modality for glioblastomas (GBMs) have not yet been established. In this study, we analyzed the outcomes of awake surgery as a treatment modality for GBMs, response to awake mapping, and the factors correlated with mapping failure. Patients with GBMs who had undergone awake surgery at our hospital between March 2010 and February 2023 were included in this study. Those with recurrence were excluded from this study. The clinical characteristics, response to awake mapping, extent of resection (EOR), postoperative complications, progression-free survival (PFS), overall survival (OS), and factors correlated with mapping failure were retrospectively analyzed. Of the 32 participants included in this study, the median age was 57 years old; 17 (53%) were male. Awake mapping was successfully completed in 28 participants (88%). A positive response to mapping and limited resection were observed in 17 (53%) and 13 participants (41%), respectively. The EOR included gross total, subtotal, and partial resections and biopsies in 19 (59%), 8 (25%), 3 (9%), and 2 cases (6%), respectively. Eight (25%) and three participants (9%) presented with neurological deterioration in the acute postoperative period and at 3 months postoperatively, respectively. The median PFS and OS were 15.7 and 36.9 months, respectively. The time from anesthetic induction to extubation was statistically significantly longer in the mapping failure cohort than that in the mapping success cohort. Functional areas could be detected during awake surgery in participants with GBMs. Thus, awake mapping influences intraoperative discernment, contributes to the preservation of brain function, and improves treatment outcomes.
清醒手术通过定位脑功能有助于实现胶质瘤的最大安全切除。然而，其作为胶质母细胞瘤（GBMs）治疗方式的有效性和安全性尚未得到证实。本研究旨在分析清醒手术作为GBMs治疗方式的临床结局、术中脑功能定位反应以及与定位失败相关的因素。研究纳入了2010年3月至2023年2月期间在我院接受清醒手术的GBMs患者，排除了复发患者。回顾性分析了患者的临床特征、清醒定位反应、切除范围（EOR）、术后并发症、无进展生存期（PFS）、总生存期（OS）以及与定位失败相关的因素。在纳入的32例患者中，中位年龄为57岁；男性17例（53%）。28例患者（88%）成功完成清醒定位。分别有17例（53%）和13例（41%）患者出现阳性定位反应和限制性切除。切除范围包括全切除、次全切除、部分切除和活检，分别为19例（59%）、8例（25%）、3例（9%）和2例（6%）。术后急性期和术后3个月分别有8例（25%）和3例（9%）患者出现神经功能恶化。中位PFS和OS分别为15.7个月和36.9个月。定位失败组从麻醉诱导到拔管的时间在统计学上显著长于定位成功组。在GBMs患者中，清醒手术期间可检测到功能区域。因此，清醒定位影响术中判断，有助于保护脑功能并改善治疗结局。
肿瘤(癌症)患者之家