Ann Surg Oncol：老龄脑肿瘤患者可安全进行清醒开颅术

　　清醒开颅术可令肿瘤得到最大程度上的切除，这与患者存活期的延长有关。但是清醒开颅术的可行性、安全性，及其对老龄人群在切除后存活期的影响程度都尚未得到确定。为此，以色列特拉维夫大学Zvi Ram博士等人进行了一项专门研究，旨在对接受清醒开颅术的老龄患者与年轻患者的预后情况进行对比。这项研究结果发表于2012年12月4日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。

　　研究人员对2003年至2010年间，在单机构接受清醒开颅术治疗的连续年轻患者以及高于65岁的老年患者进行了回顾性考察。同时，该研究对临床变量、手术预后参数，以及整体存活期进行了对比。

　　他们共对334例年轻患者(45.4± 13.2岁, 平均值± SD)与90例老龄患者(71.7± 5.1岁)进行了研究。研究人员发现，两组患者间性别、甘露醇治疗、血液动力性稳定性以及肿瘤切除情况均相似。年轻患者的Karnofsky机能评分量表得分(>70)显著高于老龄患者(P =0.0012)。老龄患者的高分级神经胶质瘤以及脑转移发生率明显较高，而低分级神经胶质瘤发生率则较低(P< 0.0001)。但研究未发现老龄患者组存在明显更高的死亡率或并发症发生率。患者年龄与住院时长增加有关(4.9 ±6.3天 vs. 6.6 ± 7.5天, P = 0.01)。神经胶质瘤患者肿瘤的最大程度切除与老龄患者的存活期延长有关。

　　Zvi Ram博士等人认为，即使对于老龄患者而言，清醒开颅术都是一种具有良好耐受性和安全性的手术类型。对神经胶质瘤老龄患者进行的肿瘤全部切除量与延长患者的存活期之间存在关联。该研究相关数据还表明，有利于恶性脑肿瘤患者的预后因素同样适用于老龄患者。　

Outcome of Elderly Patients Undergoing Awake-Craniotomy for Tumor Resection　

Background

Awake-craniotomy allows maximal tumor resection, which has been associated with extended survival. The feasibility and safety of awake-craniotomy and the effect of extent of resection on survival in the elderly population has not been established. The aim of this study was to compare surgical outcome of elderly patients undergoing awake-craniotomy to that of younger patients.

Methods

Outcomes of consecutive patients younger and older than 65 years who underwent awake-craniotomy at a single institution between 2003 and 2010 were retrospectively reviewed. The groups were compared for clinical variables and surgical outcome parameters, as well as overall survival.

Results

A total of 334 young (45.4 ± 13.2 years, mean ± SD) and 90 elderly (71.7 ± 5.1 years) patients were studied. Distribution of gender, mannitol treatment, hemodynamic stability, and extent of tumor resection were similar. Significantly more younger patients had a better preoperative Karnofsky Performance Scale score (>70) than elderly patients (P = 0.0012). Older patients harbored significantly more high-grade gliomas (HGG) and brain metastases, and fewer low-grade gliomas (P < 0.0001). No significantly higher rate of mortality, or complications were observed in the elderly group. Age was associated with increased length of stay (4.9 ± 6.3 vs. 6.6 ± 7.5 days, P = 0.01). Maximal extent of tumor resection in patients with HGG was associated with prolonged survival in the elderly patients.

Conclusions

Awake-craniotomy is a well-tolerated and safe procedure, even in elderly patients. Gross total tumor resection in elderly patients with HGG was associated with prolonged survival. The data suggest that favorable prognostic factors for patients with malignant brain tumors are also valid in elderly patients.