术前功能磁共振成像联合神经导航在岛叶胶质瘤显微手术中的应用

APPLICATION OF PEROPERATIVE FUNCTIONAL MAGNETIC RESONANCE IMAGING COMBINED WITH NEURONAVIGATION IN MICROSURGERY OF INSULAR GLIOMA

目的探讨术前功能磁共振成像联合神经导航在岛叶胶质瘤显微手术中的应用价值。方法回顾性分析2014年1月—2020年2月河北北方学院附属第一医院收治的70例行切除岛叶胶质瘤显微手术的患者资料;按照手术方式不同分为电刺激组和导航组各35例。电刺激组采用术中脑皮层电刺激技术,导航组采用术前功能磁共振成像联合神经导航技术。分别统计二组患者世界卫生组织(WHO)肿瘤级别、手术时间、住院时间、卡氏功能评分(KPS评分)等指标及肿瘤切除程度和术后随访情况。结果二组患者病理分级比较差异无统计学意义(P>0.05)。导航组肿瘤全切率高于电刺激组(P<0.05);低级别肿瘤切除率二组未见统计学意义(P>0.05),高级别肿瘤切除率导航组高于电刺激组(P<0.05)。导航组手术时间、住院时间显著短于电刺激组(P<0.05)。术后2周时导航组KPS评分显著优于电刺激组(均P<0.05),以上差异均有统计学意义。术后二组临床症状均有所好转,随访1个月~2年,二组肿瘤复发率差异未见统计学意义(P>0.05)。结论术前功能磁共振成像联合神经导航应用在岛叶胶质瘤显微手术中对患者临床症状改善作用与术中采用脑皮层电刺激技术效果相当,且能提高肿瘤全切率,有效减少手术时间。

Objective To explore the application value of preoperative functional magnetic resonance imaging combined with neuronavigation in microsurgery for resection of insular glioma.Methods Retrospective analysis was performed on 70 patients admitted to the First Affiliated Hospital of Hebei North University from January 2014 to February 2020 who underwent microsurgery to remove insular glioma.According to the operation mode, the patients were divided into electric stimulation group and navigation group, 35 cases each.The electrical stimulation group used intraoperative cerebral cortex electrical stimulation technology, and the navigation group used preoperative unctional magnetic resonance imaging combined with neuronavigation technology.The world Health Organization(WHO) tumor grade, operation time, length of hospital stay, KPS score and other indicators, tumor resection degree and postoperative follow-up were respectively counted in the two groups.Results There was no statistically significant difference in pathological grades between the two groups(P>0.05).The total tumor resection rate of navigation group was higher than that of electric stimulation group(P<0.05).There was no significant difference in the low grade tumor resection rate between the two groups(P>0.05),while the high grade tumor resection rate in the navigation group was higher than that in the electric stimulation group(P<0.05).The duration of operation and hospital stay in the navigation group was significantly shorter than that in the electric stimulation group(P<0.05).At 2 weeks after operation, KPS score of navigation group was significantly better than that of electric stimulation group(all P<0.05),above all have statistical significance.The clinical symptoms of the two groups were improved after the operation, and there was no statistically significant difference in tumor recurrence rate between the two groups after 1 month to 2 years of follow-up(P>0.05).Conclusion Preoperative functional magnetic resonance imaging combined with neuronavigation in the microsurgery of insular glioma can improve the clinical symptoms of patients with the same effect as the intraoperative use of cortical electrical stimulation technology, and can improve the total tumor resection rate, effectively reduce the operation time.