辅助运动区胶质瘤的临床特征、手术策略及疗效（附11例报告）

Clinical features, surgical strategy, and treatment outcome of glioma involving the supplementary motor area: A report of 11 cases

摘要:

目的 探讨辅助运动区（SMA）胶质瘤的临床特征、手术策略及疗效。方法 回顾性分析2021年1月至2023年12月福建医科大学附属第一医院收治的11例SMA原发胶质瘤患者的临床资料，总结其临床特征、手术策略及疗效，并对相关文献进行复习。结果 5例以癫痫发作起病，4例以头痛、头晕起病，1例以肢体无力起病，1例体检发现。肿瘤位于左侧SMA 7例，右侧SMA 4例。术中唤醒麻醉、神经导航联合电生理监测引导下切除肿瘤3例，神经导航联合电生理监测引导下切除7例，另传统开颅切除1例，全切除肿瘤8例，次全切除3例。术后10例出现SMA综合征，皆在数周至数月内恢复。术后病理，WHO Ⅱ级7例（少突胶质细胞瘤6例，弥漫性星形细胞瘤1例），WHO Ⅲ级4例（间变性弥漫性星形细胞瘤3例，间变性少突胶质细胞瘤1例）。结论 SMA胶质瘤以低级别胶质瘤多见，常以癫痫发作起病，通过多模态辅助技术引导下可做到肿瘤的最大范围安全全切除，弥散张量成像技术可于术前协助制定手术策略。术后SMA综合征常可在术后数周至数月内完全恢复。

Abstract:

Objective To investigate the clinical features， surgical strategy， and treatment outcome of glioma involving the supplementary motor area.Methods A retrospective analysis was performed for the clinical data of 11 patients with glioma involving the supplementary motor area who were admitted to The First Affiliated Hospital of Fujian Medical University from January 2021 to December 2023. The clinical features， surgical strategy， and treatment outcome of these patients were summarized， and a literature review was also performed.Results Among the 11 patients， 5 had epilepsy as the initial presentation， 4 had headache and dizziness as the initial presentation， 1 had limb weakness as the initial presentation， and 1 was identified by physical examination. Of all patients， 7 had glioma in the left supplementary motor area， and 4 had glioma in the right supplementary motor area. Among the 11 patients， 3 underwent tumor resection guided by neuronavigation and electrophysiological monitoring under intraoperative awake anesthesia， and 7 underwent tumor resection guided by neuronavigation and electrophysiological monitoring； in addition， 1 patient underwent conventional craniotomy， 8 underwent total tumor resection， and 3 underwent subtotal resection. Supplementary motor area syndrome was observed in 10 patients after surgery， and all these patients recovered within weeks to months. Postoperative pathological examination showed WHO grade Ⅱ glioma in 7 patients （6 patients with oligodendroglioma and 1 patient with diffuse astrocytoma） and WHO grade Ⅲ glioma in 4 patients （3 patients with anaplastic astrocytoma and 1 patient with anaplastic oligodendroglioma）.Conclusions Low-grade gliomas are more common in the supplementary motor area， often with epileptic seizures as the initial presentation. Safe tumor resection to the largest extent can be achieved under the guidance of multimodal adjuvant techniques， and the DTI technique can be used to develop surgical strategies. Supplementary motor area syndrome after surgery can disappear completely within weeks to months after surgery.