Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points
Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points
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DOI：
10.4103/0976-3147.188629
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发表时间：
2016-10-01
影响因子：
1.4
通讯作者：
El Refaee, Ehab
中科院分区：
文献类型：
--
作者：
Abdullah, Ahmed;El Shitany, Hisham;El Refaee, Ehab
目的：手术切除口语区的低级别胶质瘤（LGG）是神经外科的挑战之一，之前已经讨论过使用辅助工具促进有效切除并尽量减少术后神经功能缺损（清醒开颅手术和术中皮质刺激）；然而，这些工具可能有其自身的局限性，因此在许多情况下需要实施一种简单有效的技术来指导安全切除。材料和方法：作者对前瞻性收集的 76 例连续 LGG 手术病例的数据进行了回顾性分析，其中 21 例位于雄辩区。进行术前功能性磁共振成像（fMRI）、术前和术后MRI对肿瘤大小的体积分析，以及术中确定与肿瘤相关的颅骨测量点（导航引导10例），以评估上述工具在安全切除上述肿瘤中的有效性。结果：全切除14例（66.67%），次全切除6例（28.57%），活检1例（4.57%）。在长期随访中，仅1例出现持续性语言障碍。结论：尽管很简单，但在术前功能磁共振成像指导下识别安全解剖标志是一种有用的技术，可用于安全切除重要区域的 LGG。在大多数情况下，这种技术可以取代术中诱发电位或清醒开颅手术。然而，导航引导切除对于深部和大的肿瘤来说可能至关重要，以实现安全和彻底的切除。
Objectives: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre-and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow-up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.