唤醒麻醉下应用多种技术辅助显微手术治疗脑中央区低级别胶质瘤

Multiple techniques assisted microsurgery under awake anesthesia for patients with low-grade glioma in the central region

目的探讨唤醒麻醉联合多种技术辅助显微手术治疗脑中央区低级别胶质瘤的疗效。方法回顾性分析2016年1月至2021年6月在唤醒麻醉下应用多种技术辅助显微手术切除的18例脑中央区低级别胶质瘤的临床资料。术中采用唤醒麻醉、神经导航、术中超声、皮层电刺激辅助显微手术切除肿瘤。结果术后72 h内复查MRI显示肿瘤全切除11例,次全切除5例,大部切除2例。术后病理结果均为低级别胶质瘤(WHO分级Ⅰ~Ⅱ级),其中弥漫性星形细胞瘤11例,少突胶质细胞瘤2例,少突星形胶质细胞瘤5例。术后7 d,KPS评分90分3例,80分4例,70分6例,60分1例,40分4例;术后出现肢体活动障碍5例,感觉障碍7例,语言功能障碍2例。术后3个月,KPS评分90分9例,80分6例,70分2例,60分1例;仍存在运动障碍1例、感觉障碍4例,无语言障碍。术后6个月复查头部MRI显示肿瘤复发1例,术后12个月复发3例;随访期间无死亡病例。结论术中唤醒麻醉下应用多种技术辅助切除脑中央区低级别胶质瘤,有助于提高肿瘤全切除率,不增加手术并发症,明显减少术后永久性神经功能障碍。

Objective To investigate the clinical efficacy of multiple techniques assisted microsurgery under awake anesthesia for the patients with low-grade glioma in the central region.Methods The clinical data of 18 patients with low-grade glioma in the central region who underwent multiple techniques assisted microsurgery under awake anesthesia from January 2016 to June 2021 were retrospectively analyzed.Intraoperative microsurgical resection of tumor was assisted by awake anesthesia,neuronavigation,intraoperative ultrasound and cortical electrical stimulation.Results MRI within 72 h after operation showed total resection of tumor in11 patients,subtotal in 5 and great partial in 2.The postoperative pathological results showed low-grade gliomas(WHO gradeⅠ~Ⅱ)in all the patients,including 11 diffuse astrocytomas,2 oligodendrogliomas,and 5 oligodendrogliomas.Seven days after surgery,KPS score of 90 was achieved in 3 patients,score of 80 in 4,score of 70 in 6,score of 60 in 1 and score of 40 in 4.Limb movement disorder occurred in 5 patients,sensory dysfunction in 7 and language dysfunction in 2.Three months after surgery,KPS score of 90 was achieved in 9 patients,score of 80 in 6,score of 70 in 2 and score of 60 in 1.There were still movement disorder in 1 patient,and sensory disorder in 4.There was no language disorder.MRI showed tumor recurrence in 1 patient 6 months after surgery and tumor recurrence in 3patients 12 months after surgery.There were no deaths during the follow up.Conclusions For patients with low-grade glioma in the central region,multiple techniques assisted microsurgery under awake anesthesia can help to improve the total resection rate of the tumor,without increasing surgical complications,and significantly reduce the permanent neurological dysfunction.