Abstract:

Objective: To investigate the functional outcomes for patients undergoing glioma resection in the left middle precentral gyrus and posterior middle frontal gyrus, and evaluate the efficacy of current surgical strategies. Methods: A retrospective analysis was performed on the data of 7 patients who underwent glioma resection in the left middle precentral gyrus and posterior middle frontal gyrus in Huashan Hospital, Fudan University from January 2013 to July 2024. Preoperatively, the surgical plan was determined under the guidance of multimodal MRI navigation and reconstruction technology. Intraoperatively, awake craniotomy combined with direct electrical stimulation was employed to locate and protect functional areas. Preoperatively, the Mini-Mental State Examination (MMSE) was used to assess cognitive function, and the Aphasia Battery of Chinese (ABC) was used to evaluate language function. Postoperatively, the ABC scale was used to assess language function at 1, 3 and 6 months after surgery. Results: Preoperatively, 2 cases presented with mild transcortical motor aphasia, the remaining 5 cases had normal language function. In the early postoperative period, 5 cases presented with transcortical motor aphasia, one case had mixed transcortical aphasia, and one case showed normal language function. In the long-term postoperative period, 4 cases experienced mild writing dysfunction; one case exhibited mild transcortical motor aphasia, and the other 6 cases maintained normal scores for spontaneous speech, repetition, naming, and comprehension. However, 5 cases reported that their spontaneous speech was fluent but a decrease in speech rate and coordination of articulation compared to preoperative levels was noticed, and one case felt that the auditory comprehension response time had increased. The average extent of resection was 98%, with 6 cases (6/7) achieving total resection and one case (1/7) achieving partial resection (84.05%). The median follow-up duration was 69.57 (38.00, 91.00) months, one case had tumor recurrence 74 months after operation and underwent a second surgical resection, while the remaining patients did not experience recurrence. Conclusions: The combination of multimodal MRI navigation and intraoperative awake mapping with neurophysiological monitoring is crucial for optimizing functional outcomes in glioma resection within the left middle precentral gyrus and posterior middle frontal gyrus. This study highlight the critical role of this region in written language and speech motor coordination, providing important clinical evidence for the complex functions of this "non-traditional" core language area.

Key words: Glioma, Cerebral cortex, Prognosis, Language disorders, Neuronavigation, Magnetic resonance imaging, Neurophysiological monitoring

摘要：

目的: 分析左侧中央前回中部和额中回后部胶质瘤切除术后功能预后，评估手术策略的有效性。方法: 纳入2013年1月至2024年7月在复旦大学附属华山医院行左侧中央前回中部和额中回后部胶质瘤切除术的7例患者，术前在多模态MRI导航指导下确定手术方案，采取术中唤醒联合语言和运动功能区皮质及皮质下直接电刺激定位技术并保护功能区，计算肿瘤切除程度，分别于术前以及术后1、3和6个月采用汉语失语成套测验评估语言功能并计算失语商。结果: 肿瘤全切除6例、部分切除（84.05%）1例，平均肿瘤切除程度为98%。术前5例语言功能正常，2例存在轻度经皮质运动性失语。术后近期（术后1个月）5例经皮质运动性失语，1例经皮质混合性失语，1例语言功能正常。术后远期（术后3和6个月）4例遗留轻度书写障碍；1例轻度经皮质运动性失语，6例自发言语、复述、命名及理解正常，其中5例自发言语流利但自觉语速较术前减慢、发声协调运动功能减退，1例自觉听理解反应时间延长。随访时间为69.57（38.00，91.00）个月，仅1例肿瘤复发。结论: 多模态MRI导航引导下术中唤醒联合神经电生理监测对左侧中央前回中部和额中回后部胶质瘤术后功能预后具有重要意义，揭示该区域与书写及言语运动协调性的密切关系，为深入理解这一“非传统”核心语言功能区的复杂功能提供重要临床证据。

关键词: 神经胶质瘤, 大脑皮质, 预后, 语言障碍, 神经导航, 磁共振成像, 神经电生理监测