Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas
Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas
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DOI：
10.3171/2016.9.jns16152
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发表时间：
2017-10-01
影响因子：
4.1
通讯作者：
Wakabayashi, Toshihiko
中科院分区：
文献类型：
--
作者：
Motomura, Kazuya;Natsume, Atsushi;Wakabayashi, Toshihiko
目的低级别和高级别胶质瘤的最大切除范围（EOR）可以提高患者的生存率。然而，这些浸润性神经胶质瘤经常在大脑功能区附近或内部观察到。清醒手术对于与功能区相关的胶质瘤的治疗具有已知的益处，因为可以保留脑功能。另一方面，术中MRI（iMRI）已成功用于最大限度地切除肿瘤，可检测到少量残留肿瘤。因此，作者评估了清醒开颅术和iMRI相结合的价值，切除脑肿瘤的功能区的brain.METHODS作者回顾性分析了33例连续的记录与胶质肿瘤的功能区谁接受清醒手术使用iMRI。对MRI研究进行体积分析。术前，术中，术后肿瘤体积测量在所有情况下，使用MRI研究之前，期间，和之后获得的肿瘤切除术。结果术中MRI进行检查，以检查是否存在残留的肿瘤在清醒的手术过程中，共25例。初始iMRI证实9名患者（36%）没有进一步切除肿瘤，因为所有可观察到的肿瘤都已被切除。相比之下，清醒手术期间术中确认残留肿瘤导致16例（64%）进一步肿瘤切除，最终16例中有8例（50%）的EOR超过90%。此外，在16例病例中，7例（43.8%）中发现iMRI的EOR受益超过15%。有趣的是，主要与岛叶相关的肿瘤的iMRI结果的EOR增加显著更大，为15.1%，比其他肿瘤，这是8.0%（p = 0.001）。结论这项研究表明，清醒手术与iMRI相结合与功能区相关的内在脑肿瘤的良好手术结果相关。特别是，这些益处对于具有复杂解剖结构的肿瘤患者（例如与岛叶相关的肿瘤）尤为明显。
OBJECTIVE Maximum extent of resection (EOR) for lower-grade and high-grade gliomas can increase survival rates of patients. However, these infiltrative gliomas are often observed near or within eloquent regions of the brain. Awake surgery is of known benefit for the treatment of gliomas associated with eloquent regions in that brain function can be preserved. On the other hand, intraoperative MRI (iMRI) has been successfully used to maximize the resection of tumors, which can detect small amounts of residual tumors. Therefore, the authors assessed the value of combining awake craniotomy and iMRI for the resection of brain tumors in eloquent areas of the brain.METHODS The authors retrospectively reviewed the records of 33 consecutive patients with glial tumors in the eloquent brain areas who underwent awake surgery using iMRI. Volumetric analysis of MRI studies was performed. The pre-, intra-, and postoperative tumor volumes were measured in all cases using MRI studies obtained before, during, and after tumor resection.RESULTS lntraoperative MRI was performed to check for the presence of residual tumor during awake surgery in a total of 25 patients. Initial iMRI confirmed no further tumor resection in 9 patients (36%) because all observable tumors had already been removed. In contrast, intraoperative confirmation of residual tumor during awake surgery led to further tumor resection in 16 cases (64%) and eventually an EOR of more than 90% in 8 of 16 cases (50%). Furthermore, EOR benefiting from iMRI by more than 15% was found in 7 of 16 cases (43.8%). Interestingly, the increase in EOR as a result of iMRI for tumors associated mainly with the insular lobe was significantly greater, at 15.1%, than it was for the other tumors, which was 8.0% (p = 0.001).CONCLUSIONS This study revealed that combining awake surgery with iMRI was associated with a favorable surgical outcome for intrinsic brain tumors associated with eloquent areas. In particular, these benefits were noted for patients with tumors with complex anatomy, such as those associated with the insular lobe.