神经导航辅助显微手术切除大脑功能区胶质瘤☆
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摘要
目的探讨神经导航辅助显微手术切除大脑功能区胶质瘤的优势。方法回顾性分析2012年1月至2017年12月在中山大学附属第一医院行显微手术切除的大脑功能区胶质瘤99例患者的临床资料,包括神经导航组46例及非神经导航组53例。神经导航组行神经导航辅助显微手术,非神经导航组行常规显微手术。采用MRI检查、卡氏(Karnofsky Performance Scale,KPS)评分和症状改善率,对肿瘤切除程度及功能状态进行分析。结果与非神经导航组全切率73.6%(39/53)相比,神经导航组肿瘤全切率达91.3%(42/46)(Z=-2.343,P<0.05);神经导航组和非神经导航组术后症状缓解和术后KPS评分提高,与术前相比,差异均具有统计学意义(P<0.05)。除1例非神经导航组出现术后一侧肌力下降外,其余患者术后未出现症状体征加重或新的并发症。按肿瘤大小,肿瘤最大径≥3 cm患者,神经导航组与非神经导航组全切率分别为89.5%(34/38)和72.5%(37/51)(Z=-2.040,P<0.05)。结论神经导航辅助显微手术切除大脑功能区胶质瘤,可提高全切率,改善患者生存质量,不增加术后并发症。
Objective To investigate the advantage of neuronavigation assisted microsurgical resection of gliomas in eloquent areas of brain. Methods The clinical data of 99 patients with gliomas in eloquent areas of brain and underwent microsurgery in the First Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2017 were analyzed retrospectively. All patients were divided into two groups: neuronavigator-guided microsurgery group(neuronavigation group,46 cases) and non-neuronavigator-guided microsurgery group(non-neuronavigation group,53 cases). The neuronavigation group received neuronavigation assisted microsurgery, while the non-neuronavigation group received general microsurgery. MRI examination, Karnofsky performance scale(KPS) score and symptomatic improvement rate were used to analyze the extent of resection and postoperative function. Results The total resection rate of neuronavigation group was 91.3%(42/46). Comparing with 73.6%(39/53) total resection rate in non-neuronavigation group,the difference of total resection rate was statistically significant(Z=-2.343,P<0.05). The postoperative symptoms improved both in neuronavigation group and non-neuronavigation group,and the KPS score at discharge were higher than that before operation(P<0.05). No aggravation of symptoms and signs or new complications occurred in all patients except one case of postoperative muscle strength decline in non-neuronavigation group after the surgery. According to tumor size,the total resection rate of neuronavigation group and non-neuronavigation group among patients whose maximum size of tumor ≥3 cm were 89.5%(34/38) and 72.5%(37/51) respectively. The difference of total resection rate was statistically significant between these two groups(Z=-2.040,P<0.05). Conclusion Neuronavigation assisted microsurgical resection of gliomas in brain eloquent areas can improve the rate of total resection and postoperative quality of life without increase in postoperative complications.
Objective To investigate the advantage of neuronavigation assisted microsurgical resection of gliomas in eloquent areas of brain. Methods The clinical data of 99 patients with gliomas in eloquent areas of brain and underwent microsurgery in the First Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2017 were analyzed retrospectively. All patients were divided into two groups: neuronavigator-guided microsurgery group(neuronavigation group,46 cases) and non-neuronavigator-guided microsurgery group(non-neuronavigation group,53 cases). The neuronavigation group received neuronavigation assisted microsurgery, while the non-neuronavigation group received general microsurgery. MRI examination, Karnofsky performance scale(KPS) score and symptomatic improvement rate were used to analyze the extent of resection and postoperative function. Results The total resection rate of neuronavigation group was 91.3%(42/46). Comparing with 73.6%(39/53) total resection rate in non-neuronavigation group,the difference of total resection rate was statistically significant(Z=-2.343,P<0.05). The postoperative symptoms improved both in neuronavigation group and non-neuronavigation group,and the KPS score at discharge were higher than that before operation(P<0.05). No aggravation of symptoms and signs or new complications occurred in all patients except one case of postoperative muscle strength decline in non-neuronavigation group after the surgery. According to tumor size,the total resection rate of neuronavigation group and non-neuronavigation group among patients whose maximum size of tumor ≥3 cm were 89.5%(34/38) and 72.5%(37/51) respectively. The difference of total resection rate was statistically significant between these two groups(Z=-2.040,P<0.05). Conclusion Neuronavigation assisted microsurgical resection of gliomas in brain eloquent areas can improve the rate of total resection and postoperative quality of life without increase in postoperative complications.
引文
[1]NABORS L B,PORTNOW J,AMMIRATI M,et al.NCCNGuidelines Insights:Central Nervous System Cancers,Version1.2017[J].J Natl Compr Canc Netw,2017,15(11):1331-1345.
[2]HARDESTY D A,SANAI N.The value of glioma extent of resection in the modern neurosurgical era[J].Front Neurol,2012,3:140.
[3]STENO A,HOLLY V,MENDEL P,et al.Navigated 3D-ultrasound versus conventional neuronavigation during awake resections of eloquent low-grade gliomas:a comparative study at a single institution[J].Acta Neurochir(Wien),2018,160(2):331-342.
[4]庄冬晓,吴劲松,姚成军,等.3.0T术中磁共振实时影像功能导航联合术中神经电生理监测技术在岛叶胶质瘤手术中的应用[J].中国神经精神疾病杂志,2012,38(4):207-211.
[5]张家墅,陈晓雷,侯远征,等.术中磁共振联合功能神经导航在中央区胶质瘤手术的应用[J].中国神经精神疾病杂志,2012,38(4):239-243.
[6]NAIDICH T P,VALAVANIS A G,KUBIK S.Anatomic relationships along the low-middle convexity:Part I--Normal specimens and magnetic resonance imaging[J].Neurosurgery,1995,36(3):517-532.
[7]DAVIES K G,MAXWELL R E,JENNUM P,et al.Language function following subdural grid-directed temporal lobectomy[J].Acta Neurol Scand,1994,90(3):201-206.
[8]王一,柳琛.神经导航辅助下侧脑室三角区脑膜瘤显微外科手术治疗[J].中华显微外科杂志,2016,39(5):484-487.
[9]ZHANG J,CHEN X,ZHAO Y,et al.Impact of intraoperative magnetic resonance imaging and functional neuronavigation on surgical outcome in patients with gliomas involving language areas[J].Neurosurg Rev,2015,38(2):319-330,330.
[10]ORRINGER D A,GOLBY A,JOLESZ F.Neuronavigation in the surgical management of brain tumors:current and future trends[J].Expert Rev Med Devices,2012,9(5):491-500.
[11]SUN G C,WANG F,CHEN X L,et al.Impact of Virtual and Augmented Reality Based on Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation in Glioma Surgery Involving Eloquent Areas[J].World Neurosurg,2016,96:375-382.
[12]SANAI N,BERGER M S.Operative techniques for gliomas and the value of extent of resection[J].Neurotherapeutics,2009,6(3):478-486.
[13]OKAMOTO S,SHIGA T,HATTORI N,et al.Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions[J].Ann Nucl Med,2011,25(3):213-220.
[14]ZHAO X,SHEN X,CHEN X,et al.Integrated functional neuronavigation-guided resection of small meningiomas of the atrium via the paramedian parieto-occipital approach[J].Clin Neurol Neurosurg,2015,128:47-52.
[15]WANG J,DUAN Y Y,LIU X,et al.Application of intraoperative ultrasonography for guiding microneurosurgical resection of small subcortical lesions[J].Korean J Radiol,2011,12(5):541-546.
[16]ELJAMEL S,PETERSEN M,VALENTINE R,et al.Comparison of intraoperative fluorescence and MRI image guided neuronavigation in malignant brain tumours,a prospective controlled study[J].Photodiagnosis Photodyn Ther,2013,10(4):356-361.
[17]董国俊,杨佳,李莹,等.术中荧光显像辅助切除颅内肿瘤的初步研究[J].中国神经精神疾病杂志,2015,41(12):745-749.
[2]HARDESTY D A,SANAI N.The value of glioma extent of resection in the modern neurosurgical era[J].Front Neurol,2012,3:140.
[3]STENO A,HOLLY V,MENDEL P,et al.Navigated 3D-ultrasound versus conventional neuronavigation during awake resections of eloquent low-grade gliomas:a comparative study at a single institution[J].Acta Neurochir(Wien),2018,160(2):331-342.
[4]庄冬晓,吴劲松,姚成军,等.3.0T术中磁共振实时影像功能导航联合术中神经电生理监测技术在岛叶胶质瘤手术中的应用[J].中国神经精神疾病杂志,2012,38(4):207-211.
[5]张家墅,陈晓雷,侯远征,等.术中磁共振联合功能神经导航在中央区胶质瘤手术的应用[J].中国神经精神疾病杂志,2012,38(4):239-243.
[6]NAIDICH T P,VALAVANIS A G,KUBIK S.Anatomic relationships along the low-middle convexity:Part I--Normal specimens and magnetic resonance imaging[J].Neurosurgery,1995,36(3):517-532.
[7]DAVIES K G,MAXWELL R E,JENNUM P,et al.Language function following subdural grid-directed temporal lobectomy[J].Acta Neurol Scand,1994,90(3):201-206.
[8]王一,柳琛.神经导航辅助下侧脑室三角区脑膜瘤显微外科手术治疗[J].中华显微外科杂志,2016,39(5):484-487.
[9]ZHANG J,CHEN X,ZHAO Y,et al.Impact of intraoperative magnetic resonance imaging and functional neuronavigation on surgical outcome in patients with gliomas involving language areas[J].Neurosurg Rev,2015,38(2):319-330,330.
[10]ORRINGER D A,GOLBY A,JOLESZ F.Neuronavigation in the surgical management of brain tumors:current and future trends[J].Expert Rev Med Devices,2012,9(5):491-500.
[11]SUN G C,WANG F,CHEN X L,et al.Impact of Virtual and Augmented Reality Based on Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation in Glioma Surgery Involving Eloquent Areas[J].World Neurosurg,2016,96:375-382.
[12]SANAI N,BERGER M S.Operative techniques for gliomas and the value of extent of resection[J].Neurotherapeutics,2009,6(3):478-486.
[13]OKAMOTO S,SHIGA T,HATTORI N,et al.Semiquantitative analysis of C-11 methionine PET may distinguish brain tumor recurrence from radiation necrosis even in small lesions[J].Ann Nucl Med,2011,25(3):213-220.
[14]ZHAO X,SHEN X,CHEN X,et al.Integrated functional neuronavigation-guided resection of small meningiomas of the atrium via the paramedian parieto-occipital approach[J].Clin Neurol Neurosurg,2015,128:47-52.
[15]WANG J,DUAN Y Y,LIU X,et al.Application of intraoperative ultrasonography for guiding microneurosurgical resection of small subcortical lesions[J].Korean J Radiol,2011,12(5):541-546.
[16]ELJAMEL S,PETERSEN M,VALENTINE R,et al.Comparison of intraoperative fluorescence and MRI image guided neuronavigation in malignant brain tumours,a prospective controlled study[J].Photodiagnosis Photodyn Ther,2013,10(4):356-361.
[17]董国俊,杨佳,李莹,等.术中荧光显像辅助切除颅内肿瘤的初步研究[J].中国神经精神疾病杂志,2015,41(12):745-749.