岛叶胶质瘤切除术后的癫痫转归：系统评价、荟萃分析和机构经验。
Seizure outcome after resection of insular glioma: a systematic review, meta-analysis, and institutional experience.
机构信息
1Department of Neurological Surgery, University of California, San Francisco, California.
2Department of Neurosurgery, National Neuroscience Institute, Singapore; and.
出版信息
J Neurosurg. 2022 Oct 14;138(5):1242-1253. doi: 10.3171/2022.8.JNS221067. Print 2023 May 1.
OBJECTIVE
Gliomas arising from the insular cortex can be epileptogenic, with a significant proportion of patients having medically refractory epilepsy. The impact of surgery on seizure control for such tumors is not well established. In this study, the authors aimed to investigate seizure outcomes after resection of insular gliomas using a meta-analysis and institutional experience.
METHODS
Three databases (Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) were systematically searched for published studies of seizure outcomes after insular glioma resection from database inception to March 27, 2021. In addition, data were retrospectively collected on all adults (age > 17 years) who had undergone insular glioma resection between June 1997 and June 2015 at the authors' institution. Primary outcome measures were seizure freedom rates at 1 year and the last follow-up. Secondary outcome measures consisted of persistent postoperative neurological deficit beyond 90 days, mortality, and tumor progression or recurrence.
RESULTS
Eight studies reporting on 453 patients who had undergone 460 operations were included in the meta-analysis. The pooled mean age of the patients was 42 years. The pooled percentages of patients with extents of resection (EORs) ≥ 90%, 70%-89%, and < 70% were 55%, 33%, and 11%, respectively. The pooled seizure freedom rate at 1 year was 73% for Engel class IA and 78% for Engel class I. The pooled seizure freedom rate at the last follow-up was 60% for Engel class IA and 79% for Engel class I. The pooled percentage of persistent neurological deficit beyond 90 days was 3%. At the authors' institution, 109 patients had undergone resection of insular glioma. A greater EOR was the only significant independent predictor of seizure freedom after surgery (HR 0.290, p = 0.017). The optimal threshold for seizure freedom corresponded to an EOR of 81%. Patients with an EOR > 81% had a significantly higher seizure freedom rate (OR 2.16, p = 0.048).
CONCLUSIONS
Maximal safe resection can be performed with minimal surgical morbidity to achieve favorable seizure freedom rates in both the short and long term. When gross-total resection is not possible, an EOR > 81% confers the greatest sensitivity and specificity for achieving seizure freedom. Systematic review registration no.: CRD42021249404 (https://www.crd.york.ac.uk/prospero/).
目的
起源于脑岛皮质的神经胶质瘤可能具有致痫性，很大一部分患者患有药物难治性癫痫。手术对这些肿瘤的癫痫控制效果尚未得到充分证实。本研究旨在通过荟萃分析和机构经验调查岛叶胶质瘤切除术后的癫痫发作结果。
方法
系统检索了从数据库成立到 2021 年 3 月 27 日发表的关于岛叶胶质瘤切除术后癫痫发作结果的研究，检索了 Ovid MEDLINE、Embase 和 Cochrane 对照试验中心注册库 3 个数据库。此外，还回顾性收集了作者所在机构 1997 年 6 月至 2015 年 6 月期间所有接受岛叶胶质瘤切除术的成人（年龄＞17 岁）的数据。主要观察指标为 1 年和最后随访时的癫痫无发作率。次要观察指标包括术后 90 天以上持续存在的术后神经功能缺损、死亡率以及肿瘤进展或复发。
结果
纳入 8 项研究共 453 例患者的 460 例手术，进行荟萃分析。患者的平均年龄为 42 岁。肿瘤全切除（EOR）≥90%、70%-89%和＜70%的患者比例分别为 55%、33%和 11%。1 年时的癫痫无发作率为 Engel Ⅰ A 级 73%，Ⅰ级 78%。最后随访时的癫痫无发作率为 Engel Ⅰ A 级 60%，Ⅰ级 79%。术后 90 天以上持续存在神经功能缺损的比例为 3%。在作者所在机构，109 例患者接受了岛叶胶质瘤切除术。更大的 EOR 是术后癫痫无发作的唯一显著独立预测因素（HR 0.290，p=0.017）。最佳的癫痫无发作阈值对应 EOR 为 81%。EOR＞81%的患者癫痫无发作率显著更高（OR 2.16，p=0.048）。
结论
最大限度地安全切除肿瘤，同时最大限度地减少手术并发症，可在短期和长期内获得良好的癫痫无发作率。当不能实现全切除时，EOR＞81%可获得最大的敏感性和特异性以实现癫痫无发作。系统评价注册号：CRD42021249404（https://www.crd.york.ac.uk/prospero/）。
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