术中磁共振成像联合神经导航在岛叶胶质瘤显微手术中的应用
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摘要
目的:评估术中磁共振成像(intraoperative magnetic resonance imaging,i MRI)联合神经导航在切除岛叶胶质瘤中的应用价值。方法:回顾性分析2014年8月至2017年10月中山大学附属第一医院采用3.0T i MRI联合神经导航辅助手术的41例岛叶胶质瘤患者的临床资料,对切除程度、并发症及预后进行评价。结果:通过i MRI发现肿瘤次全切除21例,大部分切除20例;i MRI后再次切除。术后MRI示肿瘤全切16例,次全切18例,大部分切除7例。对比i MRI前后肿瘤切除程度,差异有统计学意义(P<0.05)。41例患者在3个月至3年的随访期间,症状有所好转。结论:i MRI联合神经导航可以及时纠正脑漂移,准确评估肿瘤切除程度,最大安全范围内切除岛叶胶质瘤。
Objective: To evaluate the value of intraoperative magnetic resonance imaging(i MRI) combined with neuronavigation for the resection of insular gliomas.Methods: From August 2014 to October 2017 in the First Hospital Affiliated to Sun Yat-sen University, clinical data of 41 patients with insular glioma, who underwent the surgery assisted with 3.0 T iMRI and neuronavigation, were analyzed retrospectively, and the resection extent, complications and prognosis were evaluated.Results: Subtotal tumor resection was achieved in 21 patients and partial resection was done in 20 af ter i MRI scanning. After further resection, total tumor resection was achieved in 16 patients, subtotal resection in 18 and partial resection in 7. There was a statistical significant difference intumor resection between pre-i MRI and post-iMRI according to the Fisher test(P<0.05). In the follow-up from 3 months to 3 years, the symptoms of the 41 patients had improved.Conclusion: iMRI corrected the shift of brain. Neuronavigation can accurately and timely assess the degree of resecting tumor. The combination of neuronavigation with surgery can maximally and safely resect insular glioma.
Objective: To evaluate the value of intraoperative magnetic resonance imaging(i MRI) combined with neuronavigation for the resection of insular gliomas.Methods: From August 2014 to October 2017 in the First Hospital Affiliated to Sun Yat-sen University, clinical data of 41 patients with insular glioma, who underwent the surgery assisted with 3.0 T iMRI and neuronavigation, were analyzed retrospectively, and the resection extent, complications and prognosis were evaluated.Results: Subtotal tumor resection was achieved in 21 patients and partial resection was done in 20 af ter i MRI scanning. After further resection, total tumor resection was achieved in 16 patients, subtotal resection in 18 and partial resection in 7. There was a statistical significant difference intumor resection between pre-i MRI and post-iMRI according to the Fisher test(P<0.05). In the follow-up from 3 months to 3 years, the symptoms of the 41 patients had improved.Conclusion: iMRI corrected the shift of brain. Neuronavigation can accurately and timely assess the degree of resecting tumor. The combination of neuronavigation with surgery can maximally and safely resect insular glioma.
引文
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[9]Ahmadi R,Dietus C,Hartmann C,et al.Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients[J].Acta Neurochir,2009,151:1359-1365.
[10]McGirt MJ,Chaichana KL,Attenello FJ,et al.Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas[J].Neurosllrgery,2008,63(4):700-707.
[11]Nimsky C,Ganslandt O,Buchfelder M,et al.Glioma surgery evaluated by intraoperative low-field magnetic resonance imaging[J].Acta Neurochir Suppl,2003,85:55-63.
[12]Bohinski RJ,Warnick RE,Gaskill-Shipley MF,et al.Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery[J].Neurosurgery,2001,49(5):1133-1144.
[13]Gerlach R,du Mesnil de Rochemont R,Gasser T,et al.Feasibility of polestar N20,an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas:lessons learned from the first 40 cases[J].Neurosurgery,2008,63(2):272-285.
[14]Kuhnt D,Ganslandt O,Schlafer SM,et al.Quantification of glioma removal by intraoperative high-field magnetic resonance imaging:an update[J].Neurosurgery,2011,69(4):852-862.
[15]McGirt MJ,Mukherjee D,Chaichana KL,et al.Association of surgically acquired motor and language deficits on overall,survival after resection of glioblastoma multiforme[J].Neurosurgery,2009,65(3):463-470.
[2]Hardesty DA,Sanai N.The value of glioma extent of resection in the modeln neurosurgieal era[J].Front Neurol,2012,3:140.
[3]Sanai N,Polley MY,McDermott MW,et al.An extent of resection threshold for newly diagnosed glioblastomas[J].J Neurosurg,2011,115(1):3-8.
[4]杜固宏,周良辅,毛颖,等.神经导航手术252例临床应用[J].中华神经外科疾病研究杂志,2002,1(4):326-329.DU Guhong,ZHOU Liangfu,MAO Ying,et al.Clinical application of neuronavigation operation in 252 cases[J].Chinese Journal of Neurosurgical Disease Research,2002,1(4):326-329.
[5]陈晓雷,许百男,王飞,等.功能神经导航及iMRI成像在语言区胶质瘤手术中的应用[J].中华外科杂志,2011,49(8):688-692.CHEN Xiaolei,XU Bainan,WANG Fei,et al.Functional neuronavigation and intraoperative magnetic resonance imaging for the resection of gliomas involving eloquent language structures[J].Chinese Journal of Neurosurgery,2011,49(8):688-692.
[6]何光建,王俊伟,邹德伟,等.岛叶胶质瘤的显微手术治疗[J].中国临床神经外科杂志,2014,19(11):645-647.HE Guangjian,WANG Junwei,ZOU Dewei,et al.Microsurgery through pterional approach for insular gliomas(report of 35cases)[J].Chinese Journal of Clinical Neurosurgery,2014,19(11):645-647.
[7]Duffau H,Capelle L.Preferential brain locations of low-grade gliomas[J].Cancer,2004,100(12):2622-2626.
[8]周劲旭,陈菊祥,徐涛,等.影响岛叶胶质瘤预后的多因素分析[J].中华神经医学杂志,2013,12(11):1136-1140.ZHOU Jinxu,CHEN Juxiang,XU Tao,et al.Influence factors affecting insular gliomas prognosis[J].Chinese Journal of Neurosurgery,2013,12(11):1136-1140.
[9]Ahmadi R,Dietus C,Hartmann C,et al.Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients[J].Acta Neurochir,2009,151:1359-1365.
[10]McGirt MJ,Chaichana KL,Attenello FJ,et al.Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas[J].Neurosllrgery,2008,63(4):700-707.
[11]Nimsky C,Ganslandt O,Buchfelder M,et al.Glioma surgery evaluated by intraoperative low-field magnetic resonance imaging[J].Acta Neurochir Suppl,2003,85:55-63.
[12]Bohinski RJ,Warnick RE,Gaskill-Shipley MF,et al.Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery[J].Neurosurgery,2001,49(5):1133-1144.
[13]Gerlach R,du Mesnil de Rochemont R,Gasser T,et al.Feasibility of polestar N20,an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas:lessons learned from the first 40 cases[J].Neurosurgery,2008,63(2):272-285.
[14]Kuhnt D,Ganslandt O,Schlafer SM,et al.Quantification of glioma removal by intraoperative high-field magnetic resonance imaging:an update[J].Neurosurgery,2011,69(4):852-862.
[15]McGirt MJ,Mukherjee D,Chaichana KL,et al.Association of surgically acquired motor and language deficits on overall,survival after resection of glioblastoma multiforme[J].Neurosurgery,2009,65(3):463-470.