岛叶胶质瘤的影像学分型及其临床意义

Imaging classification of insular gliomas and its clinical values

目的探讨基于影像学特点的岛叶胶质瘤新分型及其临床意义。方法回顾性分析2011年3月至2020年6月南京医科大学第一附属医院神经外科经病理学确诊的72例岛叶胶质瘤患者的临床资料。根据影像学特点将72例岛叶胶质瘤分为岛叶型(9例)、岛盖型(14例)、脑叶型(32例)和内侧型(17例)。进一步依据室间孔向同侧外侧裂所在平面的垂直线,将肿瘤分为前岛叶型(36例)和后岛叶型(19例)(除外内侧型)。所有患者均行开颅肿瘤切除术,其中岛叶型和岛盖型肿瘤主要采用经侧裂入路;脑叶型和内侧型肿瘤主要采用经皮质入路。分析、比较不同分型的肿瘤切除率、术后并发症及预后等情况。结果72例患者中,肿瘤全切除19例(26.4%),次全切除46例(63.9%),部分切除7例(9.7%)。术后均经病理学检查确诊,其中世界卫生组织(WHO)分级Ⅱ级25例,Ⅲ级16例,Ⅳ级31例。WHOⅡ级和Ⅲ级的岛叶胶质瘤中,岛叶型、岛盖型、脑叶型和内侧型的肿瘤切除率依次降低(F=16.94,P<0.001),岛叶型与岛盖型、脑叶型与内侧型的组间比较差异均无统计学意义(均P>0.05),其余各组间比较差异均有统计学意义(均P<0.05);WHOⅣ级岛叶胶质瘤中,岛叶型、脑叶型和内侧型的肿瘤切除率依次降低(无岛盖型)(F=17.85,P<0.001),各两组间比较差异均有统计学意义(均P<0.05)。WHOⅡ级、Ⅲ级和Ⅳ级前岛叶型胶质瘤的切除率均高于后岛叶型(均P<0.001)。后岛叶型胶质瘤患者术后发生肌力减退的概率高于前岛叶型[分别为26.3%(5/19)、16.7%(6/36),P=0.395]。术后行放化疗的患者预后较好。结论基于影像学特点的岛叶胶质瘤新分型有助于手术入路的选择和肿瘤切除率的提高。

Objective To investigate a novel imaging classification system of insular gliomas and its clinical values.Methods A retrospective analysis was conducted on the clinical data of 72 patients who were pathologically diagnosed as insular glioma at the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University from March 2011 to June 2020.According to the imaging characteristics,72 cases of insular gliomas were divided into insular lobe type(9 cases),insular operculum type(14 cases),brain lobe type(32 cases)and medial type(17 cases).According to the vertical line of the interventricular foramen to the plane of the ipsilateral sylvian fissure,the tumor was divided into anterior insular lobe type(36 cases)and posterior insular lobe type(19 cases)(except the medial type).All cases underwent craniotomy and tumor resection,which was performed primarily via transsylvian approach in insular type and operculum type,primarily via transcortical approach in brain lobe type and medial type.We then analyzed and compared the tumor resection rate,postoperative complication and outcome among different types of insular gliomas.Results Among 72 patients with insular gliomas,gross total resection was achieved in 19(26.4%)cases,subtotal resection in 46(63.9%),and partial resection in 7(9.7%).All patients were diagnosed pathologically after operation,including 25 cases of WHO gradeⅡgliomas,16 cases of WHO gradeⅢand 31 cases of WHO gradeⅣ.For WHO gradeⅡand gradeⅢinsular gliomas,the tumor resection rates of insular type,operculum type,lobe type and medial type decreased successively(F=16.94,P<0.001).There was no significant difference in the tumor resection rate between insular type and operculum type,or between lobe type and medial type(all P>0.05),while the differences among other types were statistically significant(all P<0.05).For WHO gradeⅣinsular gliomas,the tumor resection rates of insular type,lobe type and medial type decreased successively(F=17.85,P<0.001),and the differences among those types were statistically significant(all P<0.05).For WHO gradeⅡ,gradeⅢand gradeⅣinsular gliomas,the tumor resection of the anterior insular type was higher than that of the posterior insular type(all P<0.05).Patients in the posterior insular type had a higher risk of muscle weakness than those in the anterior insular types[26.3%(5/19)vs.16.7%(6/36),P=0.395].Patients with insular gliomas had a better outcome following postoperative radiotherapy and chemotherapy.Conclusion The novel classification system of insular gliomas based on imaging features could be helpful for the selection of surgical approaches and enhancement of tumor resection rate.