唤醒麻醉下皮层及皮层下电刺激联合神经导航辅助显微手术治疗岛叶胶质瘤

Microsurgery assisted by cortical and subcortical stimulation under intraoperative awake anesthesia combined with neuronavigation for patients with insular glioma

目的探讨唤醒麻醉下皮层及皮层下电刺激联合神经导航辅助显微手术治疗累及岛叶胶质瘤的效果。方法回顾性分析2016年5月至2020年6月唤醒麻醉下皮层及皮层下电刺激联合神经导航辅助显微手术治疗的7例岛叶胶质瘤的临床资料。结果术中皮质下电刺激显示6例出现运动反应,7例肿瘤切除达到功能边界。术后复查MRI显示肿瘤全切除6例,次全切除1例。术后出现一过性肢体/语言障碍6例,随访3个月,肌力Ⅲ~Ⅵ级5例,Ⅱ级1例;所有病人言语功能均恢复正常。7例术后随访24个月;术后6个月GOS评分5分2例,4分2例,3分3例;改良Rankin量表评分0分2例,2分2例,3分3例,4分2例;术后12个月复发2例(其中1例死亡),术后18个月1例复发、死亡,另4例无复发、存活。结论唤醒麻醉下皮层及皮层下电刺激联合神经导航技术有助于提高手术切除岛叶胶质瘤的安全性和肿瘤全切除率,能有效地保护肿瘤周围的重要神经结构,降低神经功能障碍发生率。

Objective To explore the effectiveness of microsurgery assisted by cortical and subcortical stimulation under intraoperative awake anesthesia combined with neuro-navigation for the patients with insular glioma.Methods A retrospective analysis was performed on the clinical data of 7 patients with insular glioma who underwent surgical resection assisted by cortical and subcortical stimulation under intraoperative awake anesthesia combined with neuro-navigation from May 2016 to June 2020.Results Intraoperative cortical and subcortical stimulation showed that 6 patients had motor response,and the tumor resection reaching the functional boundary was achieved in all the patients.Postoperative re-examination of MRI showed that the tumors were totally resected in 6 patients and subtotally in 1.Transient dysfunction of limb movement and language occurred in 6 patients after the operation;the muscle strength was recovered to gradeⅢ~Ⅵin 5 patient and gradeⅡin 1,and the dysfunction of language was recoved well in the 6 patients within 3 months.All the patients were followed up for 24 months.Six months after the operation,GOS score of 5 points was achieved in 2 patients,4 in 2,and 3 in 3;modified Rankin scale score of 0 point was achieved in 2 patients,2 in 2,3 in 3,and 4 in 2.Tumor recurrence occurred in 3 patients of whom 2 died during the follow up.Conclusions The cortical and subcortical stimulation under intraoperative awake anesthesia combined with neuro-navigation can increase the rate and safety of total tumor resection for the patients with insular glioma,which can effectively protect the important nerve structures around the tumor and reduce the incidence of neurological dysfunction.