Zusammenfassung
Hintergrund
In der neuroonkologischen Behandlung dient die Operation der Gewinnung von Gewebe für die Charakterisierung der Tumoren und der Verbesserung der Lebensqualität und Überlebenszeit.
Fragestellung
Welche Rolle spielen der Resektionszeitpunkt und das Resektionsausmaß für die Überlebenszeit und Lebensqualität und welche intraoperativen technischen Hilfsmittel stehen zur Verfügung, um diese Ziele zu erreichen.
Material und Methode
Es erfolgte eine Zusammenstellung und Diskussion von klinischen Arbeiten und Expertenmeinungen.
Ergebnisse
Die Überlebenszeit ist sowohl bei niedriggradigen als auch bei hochgradigen Gliomen abhängig vom Resektionsausmaß. Die Mehrzahl der Experten geht von Schwellenwerten des Resektionsausmaßes aus (70 % bis Komplettresektion), die erreicht werden müssen, um einen signifikanten Benefit auszuüben. Demgegenüber stehen neuere Daten, die das Konzept eines kontinuierlichen Zusammenhangs zwischen Resektionsausmaß und Überleben vorschlagen. Anderseits beeinträchtigen postoperative Defizite die Lebensqualität und wirken sich ungünstig auf die Überlebenszeit aus. Um das Resektionsausmaß zu maximieren und gleichzeitig neue neurologische Ausfälle zu vermeiden, haben sich intraoperative Techniken wie Neuronavigation, MRT, Ultraschall, fluoreszenzgestützte Chirurgie und elektrophysiologische Ableitungen etabliert. Patienten mit niedriggradigen Gliomen profitieren ebenso wie Patienten mit höhergradigen Gliomen von einer frühzeitigen Resektion.
Schlussfolgerungen
Die vorliegenden Daten sprechen unseres Erachtens für eine frühzeitige maximal sichere Resektion von hirneigenen Tumoren. Hierzu sollten alle zur Verfügung stehenden intraoperativen Hilfsmittel an den Hirntumorzentren etabliert und ausgeschöpft werden.
Abstract
Background
In neuro-oncological treatment surgery serves to obtain tissue for the characterization of tumors and to improve the quality of life and survival time.
Objective
What role does the time and extent of resection play in survival time and quality of life and what intraoperative techniques are available to achieve these goals.
Material and methods
Compilation and discussion of clinical studies and expert opinions.
Results
The survival time of both low and high-grade gliomas depends on the extent of resection. The majority of experts assume thresholds for the extent of resection (70% up to complete resection) to be achieved in order to exert a significant effect on survival. On the other hand, more recent data suggest the concept of a continuous relationship between the extent of resection and survival; however, postoperative deficits impair the quality of life and have an unfavorable effect on the survival time. Intraoperative techniques, such as neuronavigation, magnetic resonance imaging (MRI), ultrasound, fluorescence-guided surgery and electrophysiology have been established in order to maximize the extent of resection and at the same time avoid new neurological deficits. Patients with low-grade gliomas as well as high-grade gliomas benefit from early resection.
Conclusion
In our opinion, the available data speak for an early, maximally safe resection of brain tumors. For this purpose, all available intraoperative aids should be established and used at brain tumor centers.
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M. Skardelly und M. Tatagiba geben an, dass kein Interessenkonflikt besteht.
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Skardelly, M., Tatagiba, M. Die Rolle der Chirurgie bei Gliomen. Onkologe 25, 37–44 (2019). https://doi.org/10.1007/s00761-018-0502-0
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DOI: https://doi.org/10.1007/s00761-018-0502-0