最大程度安全切除大脑功能区胶质瘤的关键技术

The key techniques for safe maximal resection of cerebral functional area gliomas

目的总结最大限度安全切除大脑功能区病变的手术经验。方法回顾性分析455例大脑功能区病变的临床资料,均应用唤醒麻醉、皮质-皮质下直接电刺激脑定位、术中超声病变定位等技术,辅助手术切除病灶。着重分析285例胶质瘤病例手术切除程度与生存获益及其术后并发症。结果285例胶质瘤中,全切除222例(77.9%),次全切除37例(13.0%),部分切除22例(7.7%),活检4例(1.4%)。113例高级别胶质瘤随访76例,中位生存期27个月;172例低级别胶质瘤随访123例,中位生存期140个月。胶质瘤病人术后存在长期运动障碍17例,长期语言障碍7例。结论术中唤醒麻醉、直接电刺激功能定位以及超声定位技术,是安全可靠的脑功能区手术技术,可在保留脑功能前提下,最大限度切除脑功能区病变。

Objective To summarize the experience of safe resection of lesions in eloquent brain areas.Methods Clinical data of 455 patients with lesion in eloquent brain areas were analyzed retrospectively.The surgical resection of the lesion was assisted by awake anesthesia,cortical-subcortical direct electrical stimulation for brain mapping and ultrasound lesion localization.The extent of lesion resection,survival benefit and postoperative complications of 285 glioma patients were analyzed emphatically.Results Of the 285 gliomas,total resection was achieved in 222(77.9%),subtotal resection in 37(13.0%),partial resection in 22(7.7%)and biopsy in 4(1.4%).The 113 cases of high-grade glioma were followed up for 76 cases with a median survival of 27 months.The 172 cases of low-grade glioma were followed up for 123 cases with a median survival of 140 months.There were 17 cases of long-term motor impairment and 7 cases of long-term language impairment in patients with glioma.Conclusions Intraoperative awake anesthesia,direct electrical stimulation and ultrasound localization are safe and reliable surgical techniques for surgery on eloquent brain areas,and can help to maximize the resection of lesions in eloquent brain areas while preserving brain function.