术中高场强MRI引导下成人幕上胶质瘤切除程度的定量研究  

Quantitative study of glioma removal under the guidance of intraoperative high-field magnetic resonance imaging

作　　者：孙国臣[1,2] 朱明启[3] 陈晓雷[1] 侯远征[1,2] 余新光[1] 李安民[2] 朱儒远[1,2] 李钢[2] 周定标[1] 许百男[1] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]解放军总医院海南分院神经外科,三亚572013 [3]菏泽市立医院神经外科,274000

出　　处：《中国微侵袭神经外科杂志》2015年第5期193-195,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金资助(编号:81271515);解放军总医院科技创新苗圃基金(编号:14KMM37);海南省卫生计生行业科研项目(编号:14A210218);海南省三亚市医疗卫生科技创新项目(编号:2014YW31);海南省社会发展科技专项(编号:2015SF16)

摘　　要：目的探讨术中MRI联合功能神经导航对胶质瘤切除程度的影响。方法纳入101例成人幕上胶质瘤病人,在术中MRI联合显微镜下功能神经导航实时引导下进行手术。适时行术中MRI扫描,根据病变切除程度及其新重建的传导束,结束手术或者更新导航计划后继续切除,如此反复直到术者满意。测量手术过程中的肿瘤切除情况并进行统计分析。结果第1次术中MRI扫描时,全切除45例;继续切除后,全切除达到74例。第1次术中扫描后切除程度为95.00%（77.81%～99.65%）,与继续切除后切除程度98.15%（93.12%～100.00%）比较,差异有统计学意义（P〈0.01）。术前肿瘤的中位体积39.68（16.05～58.00）cm^3,手术结束时的中位体积为0.10（0～2.68）cm^3,手术前后肿瘤体积差异有统计学意义（P〈0.05）。术后3个月时所有病人语言功能正常,仅1例病人肢体肌力小于Ⅳ级。结论术中MRI有助于发现意外残留的肿瘤,通过进一步切除提高病变的切除程度。Objective To investigate the effect of intraoperative MRI in combination with functional neuronavigation on the resection extent of glioma. Methods One hundred and one adult patients with supratentorial glioma were included in this study, who underwent surgery under the guidance of intraoperative MRI and functional neuronavigation. Intraoperative MRI was performed based on the operators＇ need. According to the resection extent of lesion and reconstructed tracts, operators terminated surgery or continued the removal after updating navigation plan, and until the satisfactory resection extent was reached. Results Total removal was achieved in45 patients, which was confirmed by the first intraoperative MRI scan. Total removal was achieved in 74 patients after further resection.The median removal rate after the first intraoperative MRI scan was 95.00%（77.81% ～99.65%） and became 98.15%（93.12% ～100.00%） after further removal. There was a difference between the above removal rates（P 〈0.01）. The median volume of tumors before surgery was 39.68（16.05～58.00） cm^3 and 0.10（0～2.68） cm^3 after surgery. There was a difference in tumor volume before and after surgery（P〈 0.05）. During three months＇ follow-up, speech function of all the patients recovered well and only one patient had muscle strength less than grade IV. Conclusions Intraoperative MRI is helpful to identify the unexpected residual tumor, increase the resection rate by further resection and improve surgical safety.

关 键 词：神经胶质瘤 术中MRI 高场强 功能神经导航 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]