【原】【罂粟摘要】在胶质瘤手术中，标准化治疗模式作为实现最佳肿瘤功能平衡策略的应用

在胶质瘤手术中，标准化治疗模式作为实现最佳肿瘤功能平衡策略的应用

贵州医科大学              麻醉与心脏电生理课题组

翻译：田明德          编辑：田明德    审校：曹莹

背景：胶质瘤以其持续性侵袭和影响大脑关键区域的趋势为特征，由于存在神经功能缺陷的风险，对手术切除提出了挑战。这项研究的重点是在神经胶质瘤切除中实现最佳肿瘤功能平衡的个性化方法，强调最大限度地切除肿瘤，同时保持生活质量。

方法：回顾性分析了新加坡国立大学医院57例神经胶质瘤手术切除病例。纳入标准基于诊断、直接电刺激确定的功能边界、术前Karnofsky Performance Status评分以及MRI上没有多灶性疾病。治疗方法包括全面的神经心理学评估，确定清醒手术的适宜性，以及标准的睡眠-清醒-睡眠麻醉方案。系统随访肿瘤切除技术及术后护理。

结果：这项研究包括53名患者（55.5%为男性，平均年龄39岁），主要是右撇子。超过一半的人报告称癫痫发作是他们的主要主诉。肿瘤多为低度胶质瘤。所有病例均对初级运动皮层进行了阳性标测，77.2%的病例完成了清醒手术。术后1个月，26.3%的患者出现新的神经功能缺损；大多数在6个月时表现出显著改善。

结论：标准化的治疗模式有效地在胶质瘤患者中实现了最佳的功能平衡。虽然一些患者术后出现神经功能障碍，但大多数患者在3个月内恢复到术前基线。考虑到在多语言患者群体中保留多种语言的挑战，该方法优先考虑患者授权和功能映射技术的定制利用。

原始文献来源：Ngai CH, Teo C, Foo JY, et al. Application of a Standardized Treatment Paradigm as a Strategy to Achieve Optimal Onco-Functional Balance in Glioma Surgery. Brain Tumor Res Treat. 2024;12(2):100-108.

Application of a Standardized Treatment Paradigm as a Strategy to Achieve Optimal Onco-Functional Balance in Glioma Surgery

Abstract

Background: Gliomas, characterized by their invasive persistence and tendency to affect critical brain regions, pose a challenge in surgical resection due to the risk of neurological deficits. This study focuses on a personalized approach to achieving an optimal onco-functional balance in glioma resections, emphasizing maximal tumor removal while preserving the quality of life.

Method: A retrospective analysis of 57 awake surgical resections of gliomas at the National University Hospital, Singapore, was conducted. The inclusion criteria were based on diagnosis, functional boundaries determined by direct electrical stimulation, preoperative Karnofsky Performance Status score, and absence of multifocal disease on MRI. The treatment approach included comprehensive neuropsychological evaluation, determination of suitability for awake surgery, and standard asleep-awake-asleep anesthesia protocol. Tumor resection techniques and postoperative care were systematically followed.

Results: The study included 53 patients (55.5% male, average age 39 years), predominantly right-handed. Over half reported seizures as their chief complaint. Tumors were mostly low-grade gliomas. Positive mapping of the primary motor cortex was conducted in all cases, with awake surgery completed in 77.2% of cases. New neurological deficits were observed in 26.3% of patients at 1 month after operation; most showed significant improvement at 6 months.

Conclusion: The standardized treatment paradigm effectively achieved an optimal onco-functional balance in glioma patients. While some patients experienced neurological deficits postoperatively, the majority recovered to their preoperative baseline within 3 months. The approach prioritizes patient empowerment and customized utilization of functional mapping techniques, considering the challenge of preserving diverse languages in a multilingual patient population.