多模式辅助下显微手术切除“蝴蝶状”胼胝体胶质母细胞瘤临床分析  

Clinical outcome of “butterfly” corpus callosum glioblastoma treated by multimodal techniques assisted microsurgery

作　　者：周加华 郑涛 冯达云 秦怀州 杨迪 ZHOU Jiahua;ZHENG Tao;FENG Dayun;QIN Huaizhou;YANG Di(Department of Neurosurgery,Second Affiliated Hospital of PLA Air Force Medical University,Shaanxi,Xi’an 710038,China)

机构地区：[1]中国人民解放军空军军医大学第二附属医院神经外科,西安710038 [2]西安国际医学中心医院神经外科 [3]中国人民解放军空军军医大学第二附属医院放射科

出　　处：《临床外科杂志》2023年第8期718-722,共5页Journal of Clinical Surgery

基　　金：国家自然科学基金面上项目(81971129)。

摘　　要：目的 总结多模式辅助下显微手术切除“蝴蝶状”胼胝体胶质母细胞瘤(bGBM)的手术经验。方法 2016年9月~2022年9月间我院神经外科收治的胶质母细胞瘤(GBM)病人20例,均接受多模式辅助下显微外科手术。根据术前影像学特点选择最佳入路方式,利用神经导航确认手术轨迹,术中进行超声定位、神经监测或磁共振扫描。分析手术、临床结局和并发症。结果12例实现全切除,中位切除范围为96.7%(87.71%~100.0%),其中术中接受术中超声切除4例(20%),术中磁共振成像(iMRI)引导切除16例(80%),其中3例在iMRI的T1C序列上识别出残余肿瘤,在神经导航和术中神经生理监测(IONM)的辅助下继续切除残余肿瘤,最终实现全切除。新发神经功能障碍主要包括运动障碍1例、记忆障碍2例、语言障碍1例,常见于胼胝体压部、干部和膝部。最后一次随访时,存活病人中位蒙特利尔认知量表(MoCA)评分为25分,中位卡氏功能状态评分标准(KPS)为80分。中位无进展生存时间为9.3个月,中位总生存时间为11.6个月。结论 多模式技术辅助下显微手术对于bGBM可实现具有临床意义的切除,获得较良好的临床结局。Objective To report the surgical experience of “butterfly” corpus callosum glioblastoma(bGBM) resected by multimodal techniques assisted microsurgery.Methods The clinical data of 20 patients with bGBM who underwent multimodal techniques assisted microsurgery in our neurosurgery department from September 2016 to September 2022 were analyzed retrospectively.The best approach was selected according to the characteristics of preoperative imaging,and the surgical trajectory was confirmed by neuronavigation,and the ultrasound localization,nerve monitoring or magnetic resonance scanning during operation were performed.Surgical/clinical outcomes and complications were recorded.Results 12 cases achieved gross total resection and the median extent of resection was 96.7%(87.71%-100.0%).Among them,4 patients(20%) underwent intraoperative ultrasound resection,and 16 patients(80%) underwent iMRI guided resection.In which,3 patients identified residual tumors on the T1C sequence of iMRI,and continued to resect residual tumors with the assistance of neuronavigation and IONM,finally achieving total resection.New nerve dysfunction mainly includes motor disorder(1 case),memory disorder(2 cases) and language disorder(1 case),which are common in the pressure of corpus callosum,cadres and knees.At the last follow-up,the median MoCA score of survivors was 25 and the median KPS score was 80.The median disease-free survival time was 9.3 months,and the median total survival time was 11.6 months.Conclusion Multimodal techniques assisted microsurgery can achieve clinically significant resection of bGBM and obtain good clinical outcomes.

关 键 词：“蝴蝶状”胼胝体胶质瘤 神经导航 术中超声 术中神经监测 术中磁共振扫描 显微手术 

分 类 号：R739.4[医药卫生—肿瘤]