神经导航联合黄荧光辅助成像技术在脑胶质瘤手术中的应用  

Combined application of neuronavigation and yellow fluorescein-guided techniques in the operations of brain gliomas

作　　者：薛湛[1] 郝淑煜[1] 肖雄[1] 季楠[1] 吴震[1] 高之宪[1] 张力伟[1] Xue Zhan;Hao Shuyu;Xiao Xiong;Ji Nan;Wu Zhen;Gao Zhixian;Zhang Liwei(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2018年第7期690-694,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨神经导航联合黄荧光辅助成像技术在脑胶质瘤手术中的应用效果。方法回顾性纳入2014年3月至2016年3月首都医科大学附属北京天坛医院神经外科行手术治疗的37例脑胶质瘤患者，按病变部位分为幕上组（21例）和脑干组（16例）；按年龄分为成人组（25例）和儿童组（12例）。术中应用黄荧光成像技术辅助切除肿瘤（成人组和儿童组分别给予5．0mg／kg和2．5mg／kg的20％荧光素钠），切除后采用神经导航技术评估肿瘤边界，分析两种技术对肿瘤边界判断的一致性。采用术前、出院时、6个月随访时的Karnofsky功能状态评分（KPS）评估患者的生命质量。结果成人组25例中，23例术中应用黄荧光技术显像满意；儿童组12例中，1l例显像满意。对于肿瘤边界的判断，黄荧光显像与神经导航不一致者共5例，其中，幕上组4例，脑干组1例。统计学分析显示，成人组与儿童组显像满意度的差异无统计学意义（P=0．704）；幕上组与脑干组的黄荧光显像与神经导航图像的不一致性差异有统计学意义（P=0．029）。37例患者中，30例达到全切除。6个月随访时的KPS较术前改善（P=0．003）。结论对于肿瘤边界的判断，黄荧光成像与神经导航技术在脑干胶质瘤的一致性高于幕上功能区胶质瘤。对于儿童患者，使用成人剂量1／2的荧光素钠（2．5mg／kg）可获得良好的显像效果。神经导航技术与黄荧光技术联合应用，可使脑胶质瘤患者获得更好的预后。Objective To investigate the effectiveness and safety of combined application of neuronavigation and yellow fluorescein-guided techniques in the treatment of brain gliomas. Methods A total of 37 cases of brain gliomas admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from March 2014 to March 2016 were enrolled into this retrospective study. All cases were divided into supratentorial （n =21 ） and brainstem （n = 16 ） groups by location as well as adult （n = 25 ） and child （n = 12 ） groups by age. Fluorescein-guided surgery were conducted （5.0 mg/kg and 2.5 mg/kg of sodium fluorescein administered before dura opening in adult and child groups, respectively）. Following the resection, the tumor boundary was evaluated with neuronavigation. Analysis was conducted about the consistency between neuronavigation and fluorescein-guided techniques. The patient＇ s KPS （Karnofsky performance status scale） was documented and analyzed at admission, discharge and 6-month follow-up. Results Among the total 25 adult cases, 23 reported satisfactory fluorescence results, while 11 out of 12 child cases reported satisfactory results. There were 5 cases showing non-consistency between yellow fluorescein enhancement and neuronavigation which included 4 from supratentorial group and 1 from brainstem group. Statistical analysis showed no significant differences in satisfactory rate of imaging between adult and child groups （ P = 0. 704 ） and significant differences of consistency between supratentorial and brainstcm groups （ P = 0. 029）. Total resection was achieved in 30 out of 37 cases. The average KPS at 6-month follow-up was significantly higher than that at admission （ P = 0. 003 ）. Conclusions The consistency between neuronavigation and fluorescein-guided technique seems to be higher in brainstem group than in supratentorial group. Half dose of sodium fluorescein （2.5 mg/kg） might be enough for pediatric patients. Combined uses of neuronavigation and

关 键 词：神经胶质瘤 神经外科手术 神经导航 黄荧光 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]