岛叶高级别胶质瘤的手术疗效分析

目的 探讨显微手术治疗岛叶高级别胶质瘤（HGG）的疗效。方法 回顾性分析2015~2020年显微手术治疗的37例岛叶HGG的临床资料。结果 26例采用术中唤醒麻醉技术，11例应用术中监护，5例采用术中唤醒麻醉+术中监护，10例使用5-氨基乙酰丙酸荧光引导。肿瘤全切除5例，肿瘤次全切除32例。术后病理显示多形性胶质母细胞瘤11例，间变性星形细胞瘤21例，间变性少突胶质细胞瘤5例。术后出现缺血性脑卒中3例，脑积水1例，持续性非缺血性左侧肢体轻度无力1例，短暂神经系统症状3例。术后随访4.0~40.5个月，中位数17.0个月。21例（56.76%）出现肿瘤复发/进展，中位进展时间为15.0个月（4.0~38.0个月），其中8例在影像学证据显示进展前有癫痫复发。7例死亡，其中6例死于肿瘤进展，1例术后4个月死于肺动脉栓塞。随访期间，27例（72.97%）无癫痫发作，为Engel分级ⅠA级；10例（27.03%）有癫痫发作。结论 手术联合辅助技术对岛叶HGG进行最大程度地安全切除是可实现的，并且有良好的癫痫发作控制率；然而，这种益处应该与永久性神经功能缺损的风险进行权衡。对于伴癫痫发作并接受手术切除的岛叶HGG，癫痫发作结局是一个重要的衡量指标。

Clinical efficacy of surgical resection for high-grade gliomas in the insular lobe

Objective To investigate the clinical efficacy of microsurgery for the patients with insular high-grade glioma (HGG). Methods The clinical data of 37 patients with insular HGG who underwent microsurgery from 2015 to 2020 were retrospectively analyzed. Results Twenty-six patients received intraoperative wake-up anesthesia, 11 received intraoperative monitoring, 5 received intraoperative wake-up anesthesia and intraoperative monitoring, and 10 received 5-aminolevulinic acid fluorescence guidance. Total tumor resection was achieved in 5 patients and subtotal in 32. Postoperative pathological examination showed glioblastoma multiforme in 11 patients, anaplastic astrocytoma in 21, and anaplastic oligodendroglioma in 5. Ischemic stroke ocurred in 3 patients, hydrocephalus in 1, persistent non-ischemic left limb weakness in 1, and transient neurological symptoms in 3. Postoperative follow-up ranged from 4.0 months to 40.5 months, with a median of 17.0 months. Tumor recurrence/progression occurred in 21 patients (56.76%), of whom 8 patients had epilepsy recurrence before imaging evidence showing progression. Seven patients died, including six due to tumor progression and one due to pulmonary embolism 4 months after surgery. During the follow-up, 27 patients (72.97%) had no seizures (Engel class IA) and 10 (27.03%) had epileptic seizures. Conclusions Surgery combined with adjuvant techniques for maximally safe resection of insular HGG is achievable with good rates of seizure control; however, this benefit should be weighed against the risk of permanent neurological deficit. Seizure outcome is an important index of insular HGG with seizures undergoing surgical resection.