多模态神经导航及术中超声在高级别胶质瘤手术中的应用  

Application of multimodal neuronavigation and intraoperative ultrasound in the surgical treatment of highgrade glioma

作　　者：邬立 陆斌 赵蕾[2] 李方宝 鲍跃 王子君 李洛 WU Li;LU Bin;ZHAO Lei;LI Fangbao;BAO Yue;WANG Zijun;LI Luo(Department of Neurosurgery,East Branch of Zhuhai Road Municipal Hospital,Shinan District,Qingdao 266000,China)

机构地区：[1]恩施土家族苗族自治州中心医院神经外科,恩施445000 [2]青岛市市立医院东院区神经外科

出　　处：《中国神经精神疾病杂志》2022年第8期463-468,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨多模态手术(多模态影像、ROSA导航联合术中超声)对于高级别胶质瘤(high grade glioma,HGG)治疗的可行性和安全性。方法回顾分析2017年1月至2020年8月我院神经外科术后病理明确为HGG的88例患者资料。多模态组(A组,40例)应用多模式影像术前评估肿瘤,ROSA导航定位开颅部位以及精准靶向肿瘤边界并染色,术中超声实时探查肿瘤实质及边界,避免残留。另外48例(B组)患者为围手术期仅行MRI T_(1)、T_(2)为依据的显微镜手术组。收集肿瘤切除范围(extent of resection,EOR)、开颅骨窗、术后并发症(新发运动障碍或加重,新发癫痫或加重,脑积水,言语障碍,术区皮下积液,颅内感染)、术后3个月卡氏评分(Karnofsky performance status,KPS)等临床数据。结果A组病例的全切率(gross-total resection,GTR)高于B组(85.0%vs.56.2%,P=0.004)。A组开颅骨瓣面积为(25.4±9.4)cm^(2),B组为(33.0±10.2)cm^(2),组间有统计学差异(P=0.001)。A组术后并发症发生率低于B组(12.5%vs.39.6%,P=0.005)。A组术后3个月KPS评分优于B组(P=0.036)。结论多模态手术辅助HGG手术治疗可提高全切率,缩小开颅骨瓣,减少并发症,改善术后功能预后。Objective To investigate the feasibility and safety of multimodal surgery(multimodal imaging,ROSA navigation combined with intraoperative ultrasound)for the treatment of high grade glioma(HGG).Methods The data of 88 patients with HGG after neurosurgery in our hospital from January 2017 to August 2020 were retrospectively analyzed.In the multimodal group(group A,40 cases),multimodal imaging was used to evaluate the tumor before operation.ROSA navigation was used to locate the craniotomy site and accurately target the tumor boundary and stain.Intraoperative ultrasound was used to detect the tumor parenchyma and boundary in real time to avoid residual.The other 48 patients(group B)were in the microscopic surgery group based on T_(1) and T_(2) MRI only during the perioperative period.The extent of resection(EOR),cranial window opening,postoperative complications(new-onset dyskinesia or exacerbation,new-onset epilepsy or exacerbation,hydrocephalus,speech disorders,subcutaneous effusion in the operative area,intracranial infection),Karnofsky performance status(KPS)at 3 months after surgery,and other clinical data.Results The Gross Total Resection rate(GTR)in group A was significantly higher than that in group B(85.0%vs.56.2%,P=0.004).The cranial flap area in group A was(25.4±9.4)cm^(2),and that in group B was(33.0±10.2)cm^(2)(P=0.001).The incidence of postoperative complications in group A was lower than that in group B(12.5%vs.39.6%,P=0.005).The KPS score of group A was better than that of group B at 3 months after operation(P=0.036).Conclusion Multimodal surgery assisted HGG surgery can improve the total resection rate,reduce the skull flap,reduce complications,and improve the postoperative functional prognosis.

关 键 词：胶质瘤 神经导航 多模态影像 边界 美兰染色 KPS评分 术后并发症 癫痫 脑积水 颅内感染 

分 类 号：R739.4[医药卫生—肿瘤]