岛叶胶质瘤的手术治疗经验

The experience from surgical management of insular lobe gliomas

目的:总结岛叶胶质瘤的治疗经验,并探讨3.0T磁共振(magnetic resonance imaging,MRI)及术中B超技术在岛叶胶质瘤手术治疗中的应用。方法:回顾性分析18例岛叶胶质瘤患者,总结术前3.0T-MRI检查对手术参考价值并分析术中B超技术辅助肿瘤切除的意义。结果:6例(33%)患者术前因癫痫大发作和颅内压增高导致病情迅速恶化,采取急诊手术治疗,余12例患者行择期手术。术前3.0T-MRI对肿瘤边界及外侧豆纹动脉提供详细信息,术中B超可对肿瘤进行定位,并能够实时观察肿瘤切除程度,有利于最大程度切除肿瘤,但对于低级别胶质瘤,超声造影效果受限。结论:颅内压增高合并癫痫发作的岛叶胶质瘤需尽早手术。术前3.0T-MRI检查及术中B超技术有利于保护外侧豆纹动脉,并有助于最大程度切除肿瘤。

Objective：To summarize the experience of the treatment of insular lobe glioma and investigate the ap-plication of preoperative 3. 0T-MRI and intraoperative B ultrasound in the operation. Methods：A total number of 18 cases were reviewed retrospectively. The treatment processes were analyzed and the experience and lessons were pres-ented. The preoperative 3. 0T-MRI and intraoperative B ultrasound advantages and disadvantages of the two tech-niques were summarized. Results：Six cases（33%）had emergent operation due to deteriorated condition caused by increased intracranial pressure and seizure. Twelve cases had selective surgery. 3. 0T -MRI clearly visualized the LSAs and the tumor margins. B ultrasound serves as a real-time monitor and helps to remove the tumor to the grea-test degree. However,the effect of contrast-enhanced ultrasonography is limited with low grade insular glioma. Con-clusion：An early operation was necessary for the cases manifested with increased intracranial pressure and seizure. Preoperative 3. 0T-MRI and B ultrasound can help to protect the LSAs and assist the resection of insular glioma.