弥散张量纤维束成像联合神经导航在岛叶胶质瘤显微切除术中的应用

Diffusion tensor tractography combined with neuronavigation in microsurgery of insular gliomas

目的探讨弥散张量纤维束成像（DTT）联合神经导航在岛叶胶质瘤显微切除术中的应用价值。方法安徽省立医院神经外科自2013年3月至2017年10月行显微外科切除术治疗岛叶胶质瘤患者27例，术前将患者的DTT图像与神经导航结合．重建肿瘤与锥体束的三维模型，设计合适的手术入路、界定肿瘤切除范围，确认及保护术中重要血管、锥体束。回顾性分析患者的临床资料和疗效。结果本组肿瘤全切除22例（81．5％），次全切除4例（14．8％），大部分切除1例（3．7％）。术后病理显示少突胶质瘤7例，星形胶质瘤20例，其中WHO分级Ⅰ级1例，Ⅱ级18例，Ⅲ级1例。术后1例患者出现暂时性语言障碍（2周后恢复），2例患者出现对侧肢体功能障碍2例（1个月后恢复1，其余24例患者术后神经功能保留完好。结论DTT联合神经导航应用于岛叶胶质瘤显微切除术时安全、有效，可以在最大程度保护神经功能的同时最大范围地切除肿瘤，提高患者术后生存质量。

Objective To evaluate the application values of diffusion tensor tractography （DTT） combined with neuronavigation in microsurgery of insular gliomas. Methods The clinical data of 27 patients with insular gliomas, admitted to our hospital from March 2013 to October 2017, were analyzed retrospectively. All DTT images were transferred to the neuronavigation system, and the three-dimensional location of tumors and pyramidal tracts were re-constructed. Surgical approaches were designed and excision scopes were defined before the surgery. Techniques on how to distinguish and protect the key blood vessels and pyramidal tracts were discussed. The treatment efficacies were analyzed. Results Total lesion resection was achieved in 22 patients （81.5%）, subtotal resection in 4 （14.8%）, and partial resection in one （3.7%）. Postoperative pathology indicated 7 were oligodendrogliomas, and 20 were astrocytomas, including WHO grade I in one, grade II in 18, and grade HI in one. One patient had transient aphasia （recovery after two weeks）, 2 experienced worsened hemiplegia on opposite side of their bodies （normal after one month）, and the left 24 patients remained intact function after operation. Conclusions The combination of DTT and neuronavigation is safe and effective in surgical treatment for insular gliomas, which can protect the brain function at greatest degree and maximize lesion resection, and improve the postoperative quality of life.