术中磁共振实时影像导航手术切除脑胶质瘤:158例临床体会

Real-time Intraoperative Magnetic Resonance Imaging Guided Glioma Resection:Experience of 158 Cases

背景与目的:手术后肿瘤残余是影响胶质瘤患者生存的主要原因之一,应用术中磁共振影像(intraoperative magnetic resonance imaging,iMRI)导航手术,可达到最大程度切除肿瘤和保护神经功能的双重目的。本研究评估iMRI导航手术切除脑胶质瘤的近期临床疗效。方法:2006年3月至2008年6月,158例脑胶质瘤患者接受iMRI神经导航手术。结果:手术总耗时2.5～8.5h(平均5.2±1.5h)。图像质量优144例(91.1%),良9例(5.7%),差5例(3.2%)。iMRI扫描次数2～5次(平均2.5±0.7次),其中3次42例(26.6%),4次15例(9.5%),5次6例(3.2%)。39.9%的脑胶质瘤病例经iMRI发现肿瘤切除范围未达术前计划,仍需进一步切除。术后早期MRI证实肿瘤全切率达90.5%,术后严重致残率6.8%。无iMRI相关不良事件发生。结论:iMRI实时影像导航手术治疗脑胶质瘤安全有效,可实时纠正术中脑移位误差,精确定位脑胶质瘤的影像学边界,定量评估手术切除范围,有效提高肿瘤切除率。

BACKGROUND&OBJECTIVE:Tumor residue is one of the prognostic factors for glioma. With the guidance of intraoperative magnetic resonance imaging, the purpose of maximum resection of gliomas and protection of neurological function can be achieved. In this study, we evaluated the perioperative outcome of real-time intraoperative magnetic resonance imaging guidance in cerebral gliomas resection, with regard to the clinical experience in 158 cases. METHODS: From March 2006 through June 2008, 158 patients with cerebral gliomas underwent maximal safe resection by using 0.15-T iMRI in Huashan Hospital, Fudan University. RESULTS: Time consumption for surgical operation were 2.5～8.5 h (5.2±1.5 h). The quality of intraoperative imaging was excellent in 144 cases (91.1%), good in 9 cases (5.7%), and poor in 5 cases (3.2%). The number of iMRI scanning ranged from 2 to 5 per surgery (2.5±0.7). In 63 cases (39.9%),iMRI revealed residual tumor, and guided the further extensive tumor resection. The gross total resection was achieved in 143 out of 158 cases (90.5% ), while the postoperative neurological deficit was observed in 6.8% of all patients. There was no iMRI-related adverse event occurred. CONCLUSION: It is safe and effective to use iMRI in a standard neurosurgical operating room. This device provides high-quality intraoperative imaging for real time brain shift correction and quantitative tumor resection control, resulting in a maximal excision in glioma surgery.