术中磁共振成像和多模态功能神经导航在胶质母细胞瘤手术中的应用

Application of intraoperative magnetic resonance imaging and multimodal navigation in surgical resection of giioblastoma

目的评价术中磁共振成像（iMRI）和多模态功能神经导航在胶质母细胞瘤手术中的应用价值。方法2009年2月至2010年7月，76例胶质母细胞瘤患者接受iMRI和多模态功能神经导航引导下肿瘤切除术。其中男性43例，女性33例；年龄14～79岁，平均49岁。分别于首次和末次iMRI扫描时计算胶质母细胞瘤全切除率和切除程度，采用）（2检验比较全切除率。结果所有患者均成功实施iMRI和多模态功能神经导航。首次iMRI扫描时，术者对24例肿瘤切除程度判断不准确，误判率31．6％。iMRI使得本组胶质母细胞瘤的全切除率从52．6％提高至78．9％（χ^2=11．692，P=0．001），20例（26．3％）肿瘤全切除得益于iMRI扫描和多模态功能神经导航。在28例首次iMRI扫描后继续手术切除肿瘤的患者中，肿瘤平均切除程度由81．5％提高到98．1％。所有患者的平均切除程度从92．3％提高到98．4％。术后3个月随访时，3例（3．9％）患者术后神经功能障碍程度较术前加重。术后随访时间3．0～45．0个月，平均15．6个月，术后24个月累积生存率为19．7％。60例肿瘤全切除患者中位无进展生存期12个月（95％CI：10．1～13．9个月），中位总生存期16个月（95％CI：13．7～18．3个月）；16例未全切除（次全、部分切除）患者中位无进展生存期9个月（95％CI：7．9～10．1个月），中位总生存期12个月（95％CI：9．7～14．3个月），两组比较差异有统计学意义（无进展生存时间：χ^2=4．756，P=0．029；总生存时间：χ^2=7．885，P=0．005）。结论iMRI和多模态功能神经导航能够在提高胶质母细胞瘤切除程度的同时，保护患者的神经功能。

Objective To evaluate the efficacy of intraoperative magnetic resonance imaging （iMRI） and muhimodal navigation in surgical resection of glioblastoma. Methods Between February 2009 and July 2010, 76 glioblastoma patients underwent surgical resection guided by iMRI and muhimodal navigation. The cohort consisted of 43 male and 33 female patients, with a mean age of 49 years （range： 14- 79 years）. Rates of gross total resection （GTR） and extent of resection （EoR） were calculated at first and final iMRI scans. Pearson χ2 test was used to compare the rates of GTR. Results iMRI and muhimodal navigation were successfully implemented in all cases. Rates of GTR were misestimated by neurosurgeons in 24 cases （31.6%）, which were confirmed by first iMRI. Total tumor resection were achieved in 20 cases （26. 3% ） as a result of iMRI scan, increasing the rates of gross total resection from 52. 6% to 78.9% （χ2 -11. 692,P =0. 001 ）. Extent of resection in 28 patients who underwent further tumor resection were increased from 81.5% to 98. 1%, leading to the overall extent of resection improved from 92. 3% to 98.4%. At 3-month follow-up, 3 cases （3.9%） developed permanent neurologic deficits. The mean clinical follow-up was 15.6 months （ range 3.0-45.0 months）. The 2-year overall survival rate was 19.7% The median progression-free survival of gross total resection group was 12 months （95% CI： 10. 1-13.9 months）, compared with 9 months （95% CI：7.9-10. 1 months） of the subtotal resection group （ χ2 =4. 756, P = 0. 029 ） . The overall survival of gross total resection group was 16 months （ 95% CI： 13.7-18. 3 months）, compared with 12 months （95% CI： 9. 7-14. 3 months） of the subtotal resection group （χ2 = 7. 885,P = 0. 005 ）. Conclusion Combined with muhimodal navigation, iMRI helps maximize surgical resection of glioblastoma, preserving neurological function while increasing progression-free survival and overall survival.