弥散张量成像对丘脑肿瘤手术的临床意义

Value of Diffusion Tensor Imaging to microsurgery for thalamic tumors

目的探讨弥散张量成像(DTI)对提高丘脑肿瘤的全切率和降低其致残率的临床意义。方法 2009～2010年收治的18例丘脑肿瘤患者作为DTI组,术前在MRI平扫加增强的基础行DTI检查,并结合纤维束示踪技术,重建锥体束,根据肿瘤与锥体束的三维空间关系设计手术入路。2007～2009年收治的25例未行DTI检查的丘脑肿瘤患者作为对照组。两组均在神经导航下显微手术切除肿瘤,比较两组患者肿瘤全切率及术后致残率的差异。结果 DTI组肿瘤全切除12例(66.7%,12/18),部分切除4例,活检2例;术后神经功能改善10例(55.5%,10/18),无明显变化6例,恶化2例。对照组肿瘤全切除8例(32.0%,8/25),部分切除10,活检7例;术后神经功能改善7例(28.0%,7/25),无明显变化6例,恶化10,死亡2例。DTI组肿瘤全切率及术后神经功能改善率均明显高于对照组(P<0.05)。结论 DTI有助于提高丘脑肿瘤在导航下手术全切率,并有可能降低其术后致残率。

Objective To study the value of Diffusion tensor imaging （DTI） to the microsurgery for the thalamic tumors.Methods DTI was performed on the routine MRI scanning before the operation in 18 patients with thalamic tumors who were treated in our hospital from 2009 to 2010.The pyramidal tract was reconstructed by the technique of fiber tracking.The different surgical approaches were designed after the three dimensional relationship between the tumor and pyramidal tract was clearly shown.The neuronavigator-assisted microsurgery was performed in all the patients.Twenty-five patients with thalamic tumors who did not receive DTI before the operation served as control group.The rates of total resection of the tumors and disability after the operation were compared between both the groups.Results Of the 18 patients receiving DTI,12 （66.7%,12/18） underwent total resection of the tumors,4 subtotal and 2 only biopsy.The improved rate of limbs function was 55.6% （10/18） in 18 patients receiving DTI.Of 25 patients in the control group,8 （32.0,8/25） underwent the total resection of the tumors,10 subtotal and 7 only biopsy.The improved rate of limbs function was 28.0% （7/25） in the control group.The rate of total resection of tumors were significantly higher in the patients receiving preoperative DTI than that in the control group （P 0.05）.Conclusion The rate of total resection of tumors can be increased by the neuronavigator-assisted microsurgery through the approach chosen according to DTI outcomes,which probably is helpful to improving limbs function in the patients with thalamic tumors.