神经导航与术中磁共振辅助手术治疗岛叶高级别胶质瘤的预后比较

Surgical outcome of intraoperative iMRI versus conventional neuronavigation only in resection of high-grade insular glioma

目的探讨神经导航辅助和术中磁共振辅助手术治疗岛叶高级别胶质瘤的方法及预后。方法回顾分析2013年1月-2016年12月我院神经外科就诊的56例高级别胶质瘤患者的临床资料,根据手术方式分为神经导航辅助手术组(n=16)和术中磁共振辅助手术组(n=40)。导航组男性9例(56.3%),女性7例(43.7%),平均年龄(47.0±5.3)岁;磁共振辅助组男性29例(72.5%),女性11例(27.5%),平均年龄(51.0±7.1)岁;组间性别与年龄差异无统计学意义(P均<0.05)。记录两组术后肿瘤切除程度(extent of resection,EOR)、病理结果、术前KPS评分、术后放化疗等指标,并通过随访获得患者的无进展生存期(progression free survival,PFS)和总体生存期(overall survival,OS)。两组间组织病理、术前肿瘤侧别、肿瘤最大径及术前患者KPS评分均无统计学差异。结果神经导航辅助手术组全切10例(62.5%),术中磁共振辅助组全切37例(92.5%);所有患者随访12~54个月,平均随访时间28个月,术中磁共振辅助组较神经导航辅助组具有更长的PFS(39.4个月vs28.5个月,P=0.049)和OS(43.0个月vs 31.0个月,P=0.026)。COX回归分析显示手术方式(HR=0.393,P=0.024)、切除程度(HR=0.470,P=0.014)和是否应用长周期化疗方案(HR=0.410,P=0.030)为影响患者总生存时间的独立预后因素。结论术中磁共振辅助手术治疗岛叶高级别胶质瘤效果更佳,可以使患者获得较好的预后。

Objective To indentify the effect and prognosis of patients with high-grade insular glioma by neuro-navigation assisted treatment or iMRi assisted treatment. Methods Clinical data about 56 patients with high-grade gliomas admitted to our hospital from January 2013 to December 2016 were reviewed and analyzed. Then they were classified into neuro-navigation assisted group（n=16） and i MRI assisted group（n=40） according to different surgical treatments. In neuro-navigation assisted group, there were 9 males（56.3%） and 7 females（43.7%）, with mean age of（47.0±5.3） years old. In i MRI assisted group, there were 29 males（72.5%） and 11 females（27.5%）, with mean age of（51.0±7.1） years old. Extent of resection（EOR）, histological pathology, preoperative KPS score and postoperative chemoradiotherapy were compared between two groups, and survival rates including PFS and OS were collected by outpatients follow-up. There was no statistically significant difference in gender, age, tumor side, KPS score, tumor volume and pathology between the two groups. Results Of the 56 cases, 10（62.5%） cases had complete resection in neuro navigation assisted group, and 37（92.5%） cases in i MRI assisted group. All patients were followed up for 12-54 months, with mean follow-up of 28 months. iMRI assisted group displayed longer PFS（39.4 months vs 28.5 months, P =0.049） and OS（43.0 months vs 31.0 months, P =0.026）. Cox regression analysis revealed surgical method（HR =0.393, P =0.024）, extent of resection（HR =0.470, P =0.014）, and long term TMZ（HR=0.410, P=0.030） were independent prognostic factors for high-grade insular glioma. Conclusion With the clinical application of new devices such as i MRI, the intraoperative MRI assisted treatment is more effective for patients with highgrade insular glioma with better prognosis.