神经电生理联合导航技术在岛叶胶质瘤手术中的应用

Intraoperative neuronavigation and neurophysiological monitoring techniques involved in resection of insular glioma

目的:探讨提高岛叶胶质瘤手术治疗效果的方法。方法:回顾性分析2014年9月至2016年3月运用神经导航联合神经电生理技术辅助行显微手术治疗的岛叶胶质瘤患者27例(电生理导航组),以2013年1月至2014年6月未用电生理导航切除的31例岛叶肿瘤患者为对照,重点分析手术入路、肿瘤切除程度及术后神经功能损害情况。结果:电生理导航组手术入路为经侧裂入路和经皮质造瘘入路。术后影像学证实,电生理导航组全切率为48.1%,高于对照组(16.1%)(P=0.009)。电生理导航组术后新发偏瘫2例,偏瘫较术前加重2例,一过性语言功能障碍3例,术后3个月随访仍有2例偏瘫,1例失语。结论:术中配合皮层及皮层下电刺激功能区定位及神经导航可有效提高岛叶胶质瘤的手术全切率。

Aim： To explore the method to improve the operative effect of insular glioma. Methods： A series of 27 insular gliomas patients who underwent the microsurgery using the method of intraoperative neuronavigation and neurophysiological monitoring techniques were analyzed retrospectively from September 2014 to March 2016（ the electrophysiological neuronavigation group）,and 31 surgical patients with insular gliomas without electrophysiologic neuronavigation from January 2013 to June 2014 were chosen as control（ control group）. The surgical approach selection,the degree of tumor resection and postoperative functional defect were specially analyzed. Results： The surgical approach of the electrophysiological neuronavigation group included lateral fissure approach and transcortical fistula approach. According to early postoperative MRI imaging,the total removal rate of the electrophysiological neuronavigation group was 48. 1%,which was higher than that（ 16. 1%） of control group（ P = 0. 009）. There were 2 cases of new hemiplegia,2 cases of worse hemiplegia compared with preoperation,3 cases of transient speech dysfunction in the electrophysiological navigation group. After 3 months of follow-up,there were still 2 cases of hemiplegia and 1 case of aphasia. Conclusion： The technique of intraoperative neuronavigation and neurophysiological monitoring can increase total resection rate.