高场强术中磁共振对低级别胶质瘤切除程度的影响  

Influences of high-field intraoperative magnetic resonance imaging on the extent of resection in lowgrade giiomas

作　　者：张家墅[1] 陈晓雷[1] 李昉晔[1] 李晋江[1] 郑刚[1] 张挺[1] 胡深[1] 许百男[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华医学杂志》2012年第25期1738-1741,共4页National Medical Journal of China

基　　金：基金项目：国家自然科学基金（30800349）;北京市自然科学基金（7102145）

摘　　要：目的评价高场强术中磁共振（iMRI）对低级别胶质瘤切除程度的影响。方法59例低级别胶质瘤患者接受高场强iMRI联合功能神经导航下显微手术，分别于首次和末次iMRI扫描后计算肿瘤切除率和切除程度。于术前、术后及随访时评估神经功能。结果所有病例均成功实施iMRI与功能神经导航。首次iMRI发现术者对21例（35．6％）肿瘤的全切率发生误判。首次iMRI发现17例（28．8％）肿瘤残留，继续切除使8例（13．6％）得到全切。iMRI使切除程度从首次扫描后的（90±15）％提高到末次扫描后的（94±12）％（P〈0．01）。在肿瘤继续切除的17例患者中，切除程度从（78±17）％提高至（91±12）％（P〈0．01）。3个月随访时2例（3．4％）遗留神经功能障碍。结论iMRI联合功能神经导航有助于低级别胶质瘤最大限度的安全切除。Objective To evaluate the influences of high-field intraoperative magnetic resonance imaging （iMRI） on the extent of resection （EoR） in low-grade gliomas. Methods Fifty-nine patients with low-grade gliomas underwent microsurgeries under the guidance of high-field iMRI and functional neuronavigation. The rates of gross total removal and EoR were recorded after initial and final iMRI scans and neurological performances were evaluated peri-operatively and at follow-up. Results iMRI and functional neuronavigation were successfully performed in all patients. Initial iMRI found that the rates of gross total removal were misestimated in 21 cases （35.6%）. In 17 cases （28. 8% ）, initial iMRI revealed resectable residual tumors and further resection achieved gross total removal in 8 cases （ 13.6% ）. iMRI boosted the level of EoR from 90% ±15% to 94% ±12% （P〈0. 001） in all cases and from 78% ±17% to 91% ± 12% in 17 cases undergoing further tumor resections. At 3-month follow-up, 2 cases （3.4%） developed neurological deficits. Conclusion The combination of iMRI and functional neuronavigation helped maximize safe tumor resection in low-grade gliomas.

关 键 词：磁共振成像 神经导航 神经胶质瘤 外科手术 

分 类 号：R739.41[医药卫生—肿瘤]