Surgical resection of intrinsic insular tumors: complication avoidance
Surgical resection of intrinsic insular tumors: complication avoidance
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DOI：
10.3171/jns.2001.95.4.0638
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发表时间：
2001-10-01
影响因子：
4.1
通讯作者：
Sawaya, R
中科院分区：
文献类型：
--
作者：
Lang, FF;Olansen, NE;Sawaya, R
Object.对于神经外科医生来说，手术切除岛叶区域的肿瘤具有挑战性，很少有人发表他们的手术结果。作者报告了他们的经验与内在肿瘤的小脑延髓，重点是一个客观的确定范围的切除和神经系统并发症和解剖特征的分析，可能会导致次优的结果。回顾性地确定了22例接受手术切除岛叶肿瘤的患者。8例（36%）肿瘤为单纯岛状，8例（36%）延伸至颞极，6例（27%）延伸至额盖。所有病例均采用经侧裂手术入路，必要时结合额鳃盖切除术或颞叶切除术。13例肿瘤位于优势半球的患者中有5例在清醒时接受了开颅术。肿瘤切除的程度是使用体积分析来确定的。在10名患者中，6名患者切除了90%以上的肿瘤，切除了75%至90%，6名患者切除了不到75%。无患者在术后30天内死亡。术后即刻，14例患者（64%）的神经系统状况改善或无变化，8例患者（36%）恶化。缺陷包括运动或言语功能障碍。在3个月的随访检查中，只有2例患者（9%）显示永久性功能缺损。语言和运动功能障碍似乎最常见于过度的鳃盖牵拉和大脑中动脉（MCA）的操作、外侧脑纹动脉（LLAs）的中断、MCA第二段（M-2）的长穿支血管的中断或肿瘤上级方面的放射冠的侵犯。用于避免并发症的具体方法包括广泛分裂侧裂并确定岛周沟的基底以确定上级和下层切除平面，早期确定最外侧的LLA以确定内侧切除平面，在肿瘤切除前解剖MCA，在保留所有来自后M的大穿通动脉的情况下，在患者清醒的情况下进行脑刺激开颅术。对手术解剖结构的良好理解和对潜在陷阱的认识有助于减少神经系统并发症，并最大限度地切除岛叶肿瘤。
Object. Surgical resection of tumors located in the insular region is challenging for neurosurgeons, and few have published their surgical results. The authors report their experience with intrinsic tumors of the insula, with an emphasis on an objective determination of the extent of resection and neurological complications and on an analysis of the anatomical characteristics that can lead to suboptimal outcomes.Methods. Twenty-two patients who underwent surgical resection of intrinsic insular tumors were retrospectively identified. Eight tumors (36%) were purely insular, eight (36%) extended into the temporal pole, and six (27%) extended into the frontal operculum. A transsylvian surgical approach, combined with a frontal opercular resection or temporal lobectomy when necessary, was used in all cases. Five of 13 patients with tumors located in the dominant hemisphere underwent craniotomies while awake. The extent of tumor resection was determined using volumetric analyses. In 10 patients, more than 90% of the tumor was resected in six patients, 75 to 90% was resected, and in six patients, less than 75% was resected. No patient died within 30 days after surgery. During the immediate postoperative period, the neurological conditions of 14 patients (64%) either improved or were unchanged, and in eight patients (36%) they worsened. Deficits included either motor or speech dysfunction. At the 3-month follow-up examination, only two patients (9%) displayed permanent deficits. Speech and motor dysfunction appeared to result most often from excessive opercular retraction and manipulation of the middle cerebral artery (MCA), interruption of the lateral lenticulostriate arteries (LLAs), interruption of the long perforating vessels of the second segment of the MCA (M-2), or violation of the corona radiata at the superior aspect of the tumor. Specific methods used to avoid complications included widely splitting the sylvian fissure and identifying the bases of the periinsular sulci to define the superior and inferior resection planes, identifying early the most lateral LLA to define the medial resection plane, dissecting the MCA before tumor resection, removing the tumor subpially with preservation of all large perforating arteries arising from posterior M., branches, and performing craniotomy with brain stimulation while the patient was awake.Conclusions. A good understanding of the surgical anatomy and an awareness of potential pitfalls can help reduce neurological complications and maximize surgical resection of insular tumors.