神经导航及电生理监测下中央区单发转移瘤11例临床分析

A proposed scheme for the classification and surgical treatment of single brain metastasis in the central lobe using neuronavigation and neurophysiological monitoring

目的总结中央区单发转移瘤外科治疗的相关经验,以期提高患者生存率,改善疾病预后。方法本组病例分为Ⅰ型7例(皮质脊髓束位于肿瘤前方)和Ⅱ型4例(旁中央小叶受侵,皮质脊髓束位于肿瘤外侧)。分别选择经中央沟入路和对侧纵裂经大脑镰入路切除肿瘤,术后开展辅助治疗。结果肿瘤均全切,72.7%为肺腺癌转移。10例(90.9%)患者术后一个月神经功能稳定改善,无严重并发症,8例(72.7%)患者功能状态评分大于等于70。术后随访6~31个月,中位生存时间21个月。结论单发中央区转移瘤应积极开展以规范化手术切除为主的综合治疗。个体化分型和手术入路有利于全切肿瘤、保护重要神经功能、改善疾病预后。

Objective To explore the therapeutic feasibility and effects,the clinical features of patients with single perirolandic metastasis were reviewed.Methods Neuroimaging:Type I,tumors substantially shifting the corticospinal tract anteriorly(7 patients);Type II,tumors invading the paracentral lobule and shifting the corticospinal tract laterally(4 patients).All patients underwent tumor resection using intraoperative neuronavigation as well as neurophysiological monitoring.An ipsilateral trans-central sulcus approach was performed for Type I tumors,and a contralateral interhemispheric transfalcine approach for Type II.Adjuvant therapy was provided by oncologists depending on the pathological findings.Results Total resection was achieved in all cases and final pathology confirmed majority of primary tumors(72.7%)were the pulmonary adenocarcinomas.One month after removal of the tumors,10 patients(90.9%)presented with improved and stable motor function,and 8 patients(72.7%)had a Karnofsky Performance Scale(KPS)score of 70 or more.During a 6 to 31 months follow-up,5 patients died.The median overall survival time(mOS)and median progression-free survival time(mPFS)were 21 months and 12 months,respectively.Conclusion Radical resection of single perirolandic metastasis accompanied by adjuvant therapy can spare eloquent areas,and the indications of surgery should be well defined and considered.Our preliminary results suggest that the individualized scheme for classification can facilitate surgical planning and accomplish complete tumor resection with minimal invasion,permitting long-term survival.