岛叶胶质瘤的显微手术治疗(附35例分析)

Microsurgery through pterional approach for insular gliomas(report of 35 cases)

目的探讨体感诱发电位监测下利用超声刀瘤内切除岛叶胶质瘤的临床效果。方法自2009年11月至2012年6月收治岛叶胶质瘤患者35例,采用翼点入路开颅手术,广泛暴露外侧裂,术中进行体感诱发电位监测,利用超声刀首先从瘤内切除部分肿瘤,缩小肿瘤体积,进而从周围分离并切除肿瘤。结果本组肿瘤全切除21例,次全切除8例,大部分切除6例。术后病理学结果显示星形细胞瘤19例,少突胶质细胞瘤6例,间变星形细胞瘤5例,星形细胞瘤混合少突胶质细胞瘤3例,胶质母细胞瘤2例。术后25例症状较术前好转,8例无变化,2例较术前加重（1例出现永久性瘫痪）。本组无手术死亡患者。26例术后随访3个月~2年,9例失访（包括2例胶质母细胞瘤）;均经过尼莫斯汀化疗2~4个疗程,正规放疗1个疗程;肿瘤全切除病例未见肿瘤复发,症状较术前明显好转。结论在体感诱发电位监测下,充分暴露外侧裂,利用超声刀先行瘤内部分切除,缩小肿瘤体积,进而从四周分离切除肿瘤,可以提高岛叶胶质瘤的全切率,减少血管损伤引起的术后功能障碍。

ObjectiveTo investigate value of cavitron ultrasonic surgical aspirator（CUSA） under the somatosensory evokedpotential（SEP） monitoring to the resection of the insular gliomas.MethodsThe craniotomy was performed by surgery through pterionalapproach in 35 patients with insular gliomas. First, the part tumors were intratumorously resected by CUSA under SEP mornitoring inorder to decrease in the tumors volume, then, the residual tumors were separated from the tissues surrounding the tumors and resected.ResultsThe tumors were totally resected in 21 patients, subtotally in 8 and mostly in 6. The pathological examination showed thatastrocytomas were found in 19 patients, oligodendrogliomas in 6, anaplastic astrocytomas in 5, astrocytomas mixing witholigodendrogliomas in 3 and glioblastomas in 2. The preoperative neurological dysfunctions were relieved in 25 patients, unchanged in 8and aggravated in 2 after the operation. No patient died.ConclusionThe intraoperative SEP monitoring, widely splitting the Sylvainfissure, and first intratumorous removal of the part tumor with CUSA are helpful to total resection of the insular gliomas and decrease inthe neurological deficits caused by vascular injury.