脑转移瘤切除的“超边缘”理念

Supramarginal resection of brain metastases

脑转移瘤(BM)是一些恶性肿瘤的常见并发症,手术作为神经外科治疗颅脑肿瘤最传统的方式依然发挥着不可替代的作用。BM的传统全切手术后往往复发率较高,越来越多的临床与病理证据支持该类肿瘤与正常脑组织并非界限分明,致使脑转移瘤的“超边缘切除”应运而生。鉴于脑功能的保护,应用之初仅限于非功能区,现如今已携手电生理检测、导航系统、术中唤醒等精密手段走进功能区,并基于微创理念在手术入路、瘤体切除等方面不断尝试,努力在最大范围切除肿瘤与保护脑功能之间做到最优化。通过回顾大量BM的超边缘切除相关研究,该文系统阐述了该手术理念的发生与发展。

Brain metastases(BM) are a common complication of some malignant tumors,and surgery still plays an irreplaceable role as the most traditional method for neurosurgical treatment of cranial tumors.However,there is often a high recurrence rate after conventional total resection of cranial metastases,and an increasing number of clinical and pathological evidence has shown that there are no clear boundaries between these tumors and normal brain tissue,which leads to the development of "supramarginal resection" of brain metastases.It was initially limited to non-functional areas to protect brain function,and now it has been applied to functional areas in combination with the sophisticated tools such as electrophysiological examination,navigation systems,and intraoperative wake-up.Attempts have been made on surgical approach and tumor resection based on the concept of noninvasiveness,so as to achieve an optimal effect between the maximum extent of tumor resection and the maximum preservation of brain function.This article reviews the studies on supramarginal resection of BM and elaborates on the development of this surgical concept.