The goal of glioblastoma (GBM) surgery is to maximize extent of resection (EOR) while minimizing postoperative neurological complications. Awake craniotomy (AC) has been demonstrated to achieve this goal for low-grade gliomas in or near eloquent areas. However, the efficacy of AC for GBM resection has not been established. Therefore, we aimed to investigate the outcomes of AC for surgical resection of GBM using a systematic review and meta-analysis of published studies.
Methods
Systematic searches of Ovid MEDLINE, Embase, Cochrane Controlled Register of Controlled Trials (CENTRAL) and PubMed were performed from database inception to September 14, 2019 for published studies reporting outcomes of AC for GBM resection. Outcome measures analyzed included EOR and the event rate of postoperative neurological deficits.
Results
A total of 1928 unique studies were identified. Fourteen studies reporting 278 patients were included in our meta-analysis. Mean age of patients was 46.9 years (95% CI: 43.9 – 49.9). Early and late postoperative neurological deficits occurred in 34.5% (95% CI: 21.9 – 48.2) and 1.9% (95% CI: 0.0 – 9.2) of patients, respectively. Pooled percentage of gross total resection (GTR) was 74.7% (95% CI: 66.7 – 82.1), while pooled percentage reduction in tumor volume was 95.3% (95% CI: 92.2 – 98.4).
Conclusions
Limited current evidence suggests that the use of AC for resection of supratentorial GBM is associated with a low rate of persistent neurological deficits while achieving an acceptable rate of GTR. Our findings demonstrate the potential viability of AC in GBM resection and highlight the need for further research on this topic.
胶质母细胞瘤(GBM)手术的目标是较大限度地扩大切除范围(EOR),同时尽量减少术后神经系统并发症。已有证据表明,对于位于或接近口角区的低级别胶质瘤,清醒开颅术(AC)可以实现这一目标。然而,AC对GBM切除术的疗效尚未确立。因此,我们旨在通过对已发表的研究进行系统回顾和荟萃分析,调查AC用于GBM手术切除的结果。
方法
从数据库建立到2019年9月14日,对报道AC用于GBM切除术结果的已发表研究进行了Ovid MEDLINE、Embase、Cochrane对照试验登记册(CENTRAL)和PubMed的系统检索。分析的结果措施包括EOR和术后神经功能缺损的事件率。
结果
共确定了1928项独特的研究。我们的荟萃分析中纳入了14项研究,报告了278名患者。患者的平均年龄为46.9岁(95% CI:43.9 - 49.9)。术后早期和晚期神经功能缺损分别发生在34.5%(95% CI:21.9 - 48.2)和1.9%(95% CI:0.0 - 9.2)的患者中。总的全切除(GTR)的集合百分比为74.7%(95% CI:66.7 - 82.1),而肿瘤体积减少的集合百分比为95.3%(95% CI:92.2 - 98.4)。
结论
目前有限的证据表明,使用AC切除幕上GBM与低的持续神经功能缺损率有关,同时达到可接受的GTR率。我们的研究结果证明了AC在GBM切除术中的潜在可行性,并强调了对这一主题进行进一步研究的必要性。
胶质母细胞瘤(GBM)手术的目标是较大限度地扩大切除范围(EOR),同时尽量减少术后神经系统并发症。已有证据表明,对于位于或接近口角区的低级别胶质瘤,清醒开颅术(AC)可以实现这一目标。然而,AC对GBM切除术的疗效尚未确立。我们提出了一个系统性的回顾和荟萃分析,专门研究AC用于GBM的结果。我们的研究结果表明,使用AC切除舌上型GBM与较低的术后持续神经功能缺损率有关,同时达到可接受的GTR率。我们的研究结果证明了AC用于口才区或附近GBM切除的可行性。
胶质母细胞瘤(Glioblastoma,GBM)是较常见和较致命的恶性脑肿瘤,在美国占全部恶性中枢神经系统肿瘤的48.3%,每年的发病率为十万分之三点二。在美国,它占全部恶性中枢神经系统肿瘤的48.3%,年发病率为3.22/10万。1被国际卫生组织(WHO)列为IV级胶质瘤,它具有较强的侵袭性,并具有迅速侵入周围脑实质的能力。由于这种浸润性,手术完全切除几乎不可能。再加上对化疗和放疗的敏感性较差,GBM不可避免地会复发,尽管进行了较好的治疗,但仍是致命的2-4,GBM治疗后的中位生存期约为15个月,有6.8%的患者从诊断时起存活5年以上。
总之,目前关于AC用于肿瘤上皮GBM切除术的证据主要限于小型回顾性研究。在这些研究中,AC既能达到可接受的GTR率,又能达到较低的持续性神经功能缺损率。据我们所知,这是一个专门研究AC在GBM中作用的系统性回顾和荟萃分析。该研究结果说明了AC对位于或接近口角区的舌上型GBM患者的潜在可行性,并强调了未来前瞻性研究的必要性,以更好地确定其疗效和结果。
原文链接:https://www.sci-hub.se/10.1093/noajnl/vdaa111