The Value of Pre- and Intraoperative Adjuncts on the Extent of Resection of Hemispheric Low-Grade Gliomas: A Retrospective Analysis
The Value of Pre- and Intraoperative Adjuncts on the Extent of Resection of Hemispheric Low-Grade Gliomas: A Retrospective Analysis
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DOI：
10.1055/s-0035-1551830
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发表时间：
2016-03-01
影响因子：
1
通讯作者：
Golby, Alexandra
中科院分区：
文献类型：
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作者：
Incekara, Fatih;Olubiyi, Olutayo;Golby, Alexandra
背景：在低级别胶质瘤（LGG）手术中，为了实现最大程度的切除和最小的术后神经系统并发症风险，不同的神经外科辅助手术正在被使用。目的探讨术前和术中辅助物对半球形LGGs切除范围的影响。方法回顾性分析2005年1月至2013年7月在X医院行LGG手术的患者的病历，患者性别不限，年龄bb0 = 18岁。根据使用单独神经导航系统（NN）、功能性MRI弥散张量成像（fMRI-DTI）引导神经导航（FD）、术中MRI （MR）和直接电刺激（DES）的不同组合，将患者分为8个亚组。测量初始肿瘤和残余肿瘤，比较各组平均EOR。结果128例患者总切除率为23.4%。总体平均EOR为81.3% +/- 20.5%。与单独使用神经网络相比，使用DES联合fMRI-DTI治疗雄辩性肿瘤（平均EOR: 86.7% +/- 12.4%）在调整潜在混杂因素后显著提高了平均EOR（平均EOR: 76.4% +/- 25.5%; p = 0.001）。结论与仅使用神经网络的开颅手术相比，当lgg位于有效区时，使用DES联合fMRI和DTI可显著提高EOR。
Background To achieve maximal resection with minimal risk of postoperative neurologic morbidity, different neurosurgical adjuncts are being used during low-grade glioma (LGG) surgery.Objectives To investigate the effect of pre- and intraoperative adjuncts on the extent of resection (EOR) of hemispheric LGGs.Methods Medical records were reviewed to identify patients of any sex, >= 18 years of age, who underwent LGG surgery at X Hospital between January 2005 and July 2013. Patients were divided into eight subgroups based on the use of various combinations of a neuronavigation system alone (NN), functional MRI-diffusion tensor imaging (fMRI-DTI) guided neuronavigation (FD), intraoperative MRI (MR), and direct electrical stimulation (DES). Initial and residual tumors were measured, and mean EOR was compared between groups.Results Of all 128 patients, gross total resection was achieved in 23.4%. Overall mean EOR was 81.3% +/- 20.5%. Using DES in combination with fMRI-DTI (mean EOR: 86.7% +/- 12.4%) on eloquent tumors improved mean EOR significantly after adjustment for potential confounders when compared with NN alone (mean EOR: 76.4% +/- 25.5%; p = 0.001).Conclusions Using DES in combination with fMRI and DTI significantly improves EOR when LGGs are located in eloquent areas compared with craniotomies in which only NN was used.