中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (2): 333-337.doi: 10.4103/1673-5374.290901

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

手术切除临近弓状束胶质瘤易损伤语言功能和危险因素

  

  • 出版日期:2021-02-15 发布日期:2020-12-03
  • 基金资助:

    解放军总医院临床研究资助基金项目(2017FC-TSYS-2012);海南省自然科学基金青年项目(819QN378);国家自然科学基金面上项目(81771481);国家重点研究开发计划项目(2018YFC1312602);国家老年病临床研究中心项目(NCRCGPLAGH-2017007

Identification of risk factors for poor language outcome in surgical resection of glioma involving the arcuate fasciculus: an observational study

Fang-Ye Li1, 2, #, Hong-Yu Liu2, #, Jun Zhang1, #, Zheng-Hui Sun1, 2, Jia-Shu Zhang1, Guo-Chen Sun1, Xin-Guang Yu1, Xiao-Lei Chen1, *, Bai-Nan Xu1, *#br#   

  1. 1 Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China;   2 Department of Neurosurgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan Province, China
  • Online:2021-02-15 Published:2020-12-03
  • Contact: Bai-Nan Xu, MD, PhD, xubainan301@163.com; Xiao-Lei Chen, MD, PhD, chxlei@mail.sysu.edu.cn.
  • Supported by:
    This study was supported by Clinical Research Fostering Fund of Chinese PLA General Hospital in China, No. 2017FC-TSYS-2012 (to FYL); Youth Program of the Natural Science Foundation of Hainan Province of China, No. 819QN378 (to FYL); the National Natural Science Foundation of China, No. 81771481 (to XLC); China National Key R&D Program, No. 2018YFC1312602 (to XLC); National Clinical Research Center for Geriatric Diseases of China, No. NCRCG-PLAGH-2017007 (to XLC).

摘要:

基于人类语言网络重要组成部分的弓状束,切除肿瘤时常易损伤此区域。此次前瞻性研究拟评估磁共振成像和弥散张量成像术中指导下手术切除临近弓状束的神经胶质瘤的结局,并确定影响术后语言缺陷的危险因素。(1)试验招募54例原发性临近弓状束神经胶质瘤患者,其中男38例,女16例,年龄43±11岁。所有患者通过基于术中磁共振成像和基于弓状束的弥散张量成像手术切除肿瘤,如需进一步切除则更新术中图像。(2)结果显示,术中磁共振成像将54例患者的总切除率从38.9%提高到70.4%,使17例患者受益。在最后一次扫描中,54例神经胶质瘤患者的切除范围从92.1%增加到96.8%;(3)术前语言功能和肿瘤与弓状束距离与不良的语言结局有关。多变量逻辑回归分析表明,肿瘤与弓状束距离是不良预后的关键独立危险因素,其临界点为3.2mm;(4)试验结果证实,术中磁共振成像与基于弓状束的弥散张量成像相结合,可最大程度地切除临近弓状束胶质瘤,且对语言功能的影响最小,同时肿瘤与弓状束距离被认为是造成术后语言功能恶化关键的独立危险因素。研究已于2014年10月11日经解放军总医院伦理委员会批准,批准号S2014-096-01。

https://orcid.org/0000-0001-6880-8311 (Fang-Ye Li)

关键词: 中枢神经系统, 脑, 术中磁共振成像, 扩散张量成像, 弓形束, 语言功能, 风险因素, 临床研究

Abstract: The arcuate fasciculus is a critical component of the neural substrate of human language function. Surgical resection of glioma adjacent to the arcuate fasciculus likely damages this region. In this study, we evaluated the outcome of surgical resection of glioma adjacent to the arcuate fasciculus under the guidance of magnetic resonance imaging and diffusion tensor imaging, and we aimed to identify the risk factors for postoperative linguistic deficit. In total, 54 patients with primary glioma adjacent to the arcuate fasciculus were included in this observational study. These patients comprised 38 men and 16 women (aged 43 ± 11 years). All patients underwent surgical resenction of glioma under the guidance of magnetic resonance imaging and diffusion tensor imaging. Intraoperative images were updated when necessary for further resection. The gross total resection rate of the 54 patients increased from 38.9% to 70.4% by intraoperative magnetic resonance imaging. Preoperative language function and glioma-to-arcuate fasciculus distance were associated with poor language outcome. Multivariable logistic regression analyses showed that glioma-to-arcuate fasciculus distance was the major independent risk factor for poor outcome. The cutoff point of glioma-to-arcuate fasciculus distance for poor outcome was 3.2 mm. These findings suggest that intraoperative magnetic resonance imaging combined with diffusion tensor imaging of the arcuate fasciculus can help optimize tumor resection and result in the least damage to the arcuate fasciculus. Notably, glioma-to-arcuate fasciculus distance is a key independent risk factor for poor postoperative language outcome. This study was approved by the Ethics Committee of the Chinese PLA General Hospital, China (approval No. S2014-096-01) on October 11, 2014.

Key words: arcuate fasciculus, central nervous system, brain, diffusion tensor imaging, intraoperative magnetic resonance imaging, language function, risk factor, trial