Post-operative morbidity ensuing surgery for insular gliomas: a systematic review and meta-analysis
| Autor: | Riccardo Morganti, Davide Tiziano Di Carlo, Federico Cagnazzo, Paolo Perrini, Nicola Benedetto, Yury Anania, Hugues Duffau |
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| Přispěvatelé: | Azienda Ospedaliera Universitaria Pisana, Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Neurochirurgie [Hôpital Gui de Chauliac], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], University of Pisa - Università di Pisa |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Neuronavigation [SDV]Life Sciences [q-bio] Neurological morbidity Neurosurgical Procedures 030218 nuclear medicine & medical imaging Insular surgery 03 medical and health sciences Postoperative Complications 0302 clinical medicine medicine.artery Glioma medicine Humans Neurophysiological Monitoring Brain Neoplasms business.industry General Medicine Middle Aged medicine.disease Meta-analysis Post operative morbidity 3. Good health Surgery Awake surgery Perforating arteries Middle cerebral artery Female Neurology (clinical) business Craniotomy Insular glioma 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgical Review Neurosurgical Review, Springer Verlag, 2020, 43 (3), pp.987--997. ⟨10.1007/s10143-019-01113-4⟩ |
| ISSN: | 1437-2320 0344-5607 |
| DOI: | 10.1007/s10143-019-01113-4 |
| Popis: | International audience; The surgical resection of insular gliomas remains a challenge. Middle cerebral artery perforating arteries and deep functional pathways affect the extent of resection and the rate of post-operative morbidity. The authors performed a systematic review and meta-analysis of the literature examining early and permanent post-operative deficits in patients who underwent resection of insular gliomas using awake craniotomy with direct electrical stimulation (DES) versus surgery under general anesthesia. A systematic search of three databases was performed for studies published between 1990 and 2018. Random-effect meta-analysis was used to pool the rate of early and permanent post-operative deficits. Random-effect meta-regression was used to examine the association between the rate of post-operative deficit and the anesthesia protocol. We included eight studies evaluating 227 patients with insular glioma. The rate of permanent sequelae was lower after awake craniotomy with DES (3.5% vs 15.7%; P = .001), and early deficits were lower after surgery under general anesthesia (27.3% vs 47.7%; P = .04). Awake surgery was significantly more common among patients with tumor located within the dominant hemisphere (P < .001). No significant association arose between the rates of post-operative deficits and the use of intraoperative neuronavigation and the neurophysiological monitoring. Furthermore, neither extent of resection nor tumor histology influenced the onset of permanent sequelae. Awake craniotomy with DES is associated with a significantly lower rate of permanent neurological morbidity after an early increase of transient post-operative deficits. These data support the use of awake mapping in insular glioma resection. |
| Databáze: | OpenAIRE |
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