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首页> 外文期刊>Journal of neurosurgery. >Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients.
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Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients.

机译：大脑皮层皮下神经胶质瘤的术中皮层下刺激图，位于运动下降路径内或附近：294例患者的发病率评估和功能结局评估。

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OBJECT: Intraoperative stimulation mapping of subcortical white matter tracts during the resection of gliomas has become a valuable surgical adjunct that is used to reduce morbidity associated with tumor removal. The purpose of this retrospective analysis was to assess the morbidity and functional outcome associated with this method, thus allowing the surgeon to predict the likelihood of causing a temporary or permanent motor deficit. METHODS: In this study, the authors report their experience with intraoperative stimulation mapping to locate subcortical motor pathways in 294 patients who underwent surgery for hemispheric gliomas within or adjacent to the rolandic cortex. Data were collected regarding intraoperative cortical and subcortical stimulation mapping results, along with the patient's neurological status pre- and postoperatively. For patients in whom an additional motor deficit occurred postoperatively, its evolution was examined. Of 294 patients, an additional postoperative motor deficit occurred in 60 (20.4%). Of those 60, 23 (38%) recovered to their preoperative baseline status within the 1st postoperative week. Another 12 (20%) recovered from their postoperative motor deficit by the end of the 4th postoperative week, and 11 more recovered to their baseline status by the end of the 3rd postoperative month. Thus, 46 (76.7%) of 60 patients with postoperative motor deficits regained their baseline function within the first 90 days after surgery. The remaining 14 patients (4.8% of the entire study population of 294) had a persistent motor deficit after 3 months. Patients whose subcortical pathways were identified with stimulation mapping were more prone to develop an additional (temporary or permanent) motor deficit than those in whom subcortical pathways could not be identified (27.5% compared with 13.1%, p = 0.003). This was also true when additional (permanent) motor deficits lasted more than 3 months (7.4% when subcortical pathways were found, compared with 2.1% when they were not found; p = 0.041). CONCLUSIONS: In patients with gliomas that are located within or adjacent to the rolandic cortex and, thus, the descending motor tracts, stimulation mapping of subcortical pathways enables the surgeon to identify these descending motor pathways during tumor removal and to achieve an acceptable rate of permanent morbidity in these high-risk functional areas.
机译：目的：在脑胶质瘤切除术中对皮层下白质束进行术中刺激定位已成为一种有价值的手术辅助工具，可用于减少与切除肿瘤相关的发病率。这项回顾性分析的目的是评估与该方法相关的发病率和功能结局，从而使外科医生可以预测引起暂时或永久性运动功能障碍的可能性。方法：在这项研究中，作者报告了他们在术中刺激映射中定位294例在罗兰蒂皮层内或附近接受半球神经胶质瘤手术的患者皮层下运动通路的经验。收集有关术中皮层和皮层下刺激图结果以及患者术前和术后神经系统状况的数据。对于术后又出现运动障碍的患者，检查其演变。在294例患者中，另外60例发生了术后运动功能障碍（20.4％）。在这60名患者中，有23名（38％）在术后第一周内恢复到术前基线状态。术后第4周结束时，又有12名（20％）从术后运动障碍中恢复过来，在术后第3个月末，又有11名恢复到基线状态。因此，在60名术后运动功能障碍的患者中，有46名（76.7％）在术后头90天内恢复了基线功能。其余14例患者（占294位研究人群的4.8％）在3个月后出现持续性运动障碍。与无法识别皮层下途径的患者相比，通过刺激图识别​​出皮层下途径的患者更容易出现额外的（暂时或永久性）运动功能障碍（27.5％比13.1％，p = 0.003）。当其他（永久性）运动功能障碍持续超过3个月时也是如此（发现皮层下途径的比例为7.4％，而未发现皮层下途径的比例为2.1％; p = 0.041）。结论：在神经胶质瘤患者位于或位于rolandic皮质内并因此而下降的运动区中，皮层下通路的刺激图使外科医生能够在切除肿瘤期间识别出这些下降的运动通路并达到可接受的永久率这些高风险功能区域的发病率。

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