Temporal Glioblastoma Mimicking Basal Ganglia Invasion: Distinguishing Removable and Unremovable Tumors
Temporal Glioblastoma Mimicking Basal Ganglia Invasion: Distinguishing Removable and Unremovable Tumors
复制标题
模仿基底神经节侵袭的颞部胶质母细胞瘤：区分可切除和不可切除的肿瘤
DOI：
10.1016/j.wneu.2019.06.035
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发表时间：
2019
影响因子：
2
通讯作者：
Toshihiro Kumabe
中科院分区：
文献类型：
--
作者：
Ichiyo Shibahara 1;Mitsuto Hanihara;Kazuhiro Miyasaka;Sumito Sato;Takuichiro Hide;Toshihiro Kumabe
目的最大限度的安全切除可延长胶质母细胞瘤（GB）患者的生存期。然而，是否继续或放弃对增强病灶的全切除取决于术前根据磁共振成像（MRI）结果的判断。解剖上，内侧颞叶肿瘤易向颞干、脑岛、基底神经节侵犯，是手术风险较高的肿瘤。在本研究中，我们描述了内侧颞部GB的关键放射学特征，以实现切除的程度。方法回顾2013年4月至2018年3月在北中大学医院治疗的所有颞叶GB病例。根据MRI将tGB简单分为内侧tGB和非内侧tGB 3组，并将内侧tGB进一步细分为侵袭型和模拟型。我们关注内侧tGB的可切除性。结果共检出tGB患者27例。非内侧tGB 20例，内侧tGB 7例。所有内侧tGB似乎都侵犯基底节区和/或纹状体状动脉，但详细检查显示2种类型的肿瘤，侵袭型（3例）和模拟型（4例）。入侵型确实累及基底神经节和/或透镜状纹状动脉，而模拟型没有累及这些结构。这种新的分类是非常有效的，因为前者是不可切除的，而后者是完全可切除的。结论内侧tGB是一种难以最大限度安全切除的肿瘤，因此我们的分类有助于识别可切除的内侧tGB病例。
ObjectiveMaximal safe resection prolongs the survival of patients with glioblastoma (GB). However, whether total resection of the enhanced lesion is pursued or abandoned depends on preoperative judgments based on the findings of magnetic resonance imaging (MRI). Anatomically, medial temporal tumor tends to invade toward the temporal stem, insula, and basal ganglia, representing tumor with high surgical risk. In the present study, we describe the key radiologic features of medial temporal GB to achieve extent of resection.MethodsWe reviewed all GB cases located in the temporal lobe (tGB) treated between April 2013 and March 2018 at Kitasato University Hospital. On the basis of MRI, tGB was simply classified into 3 groups: medial tGB and nonmedial tGB, and medial tGB was further subdivided into invading type and mimicking type. We focused on the resectability of medial tGB.ResultsTwenty-seven patients with tGB were identified. Twenty were included in the nonmedial tGB, and 7 were in the medial tGB. All medial tGB seemed to invade into the basal ganglia and/or the lenticulostriate arteries, but detailed examination revealed 2 types of tumor, invading type (3 cases) and mimicking type (4 cases). The invading type had true involvement of the basal ganglia and/or lenticulostriate arteries, whereas the mimicking type had no involvement of these structures. This new classification is highly effective, as the former is unresectable, but the latter is totally resectable.ConclusionsMedial tGB is a challenging tumor for maximal safe resection, so our classification will help to identify cases of removable medial tGB.