岛叶脑胶质瘤显微镜下切除术中不同神经导航辅助技术对切除效果、神经肽水平及术后认知功能的影响

Effects of Different Neuronavigation Aids during Microscopic Resection of Insular Glioma on Resection Results,Neuropeptide Levels and Postoperative Cognitive Function

目的分析岛叶脑胶质瘤显微镜下切除术中不同神经导航辅助技术对切除效果、神经肽水平及术后认知功能的影响。方法选取2016年3月至2021年3月南充市中心医院收治的69例行显微镜下切除术治疗的岛叶脑胶质瘤患者为研究对象,根据神经导航辅助技术的不同分为电生理导航组(33例)和磁共振导航组(36例)。其中,电生理导航组采用神经电生理技术结合神经导航技术辅助显微手术,磁共振导航组采用磁共振成像(MRI)结合神经导航技术辅助显微手术。比较两组患者的围手术期指标(手术时间、住院时间)、肿瘤切除情况、术后情况(临床表现、新发癫痫发生率)、神经肽[生长抑素(SS)、神经降压素(NT)、催产素(OT)、β-内啡肽(β-EP)、精氨酸升压素(AVP)]水平及认知功能[简易精神状态检查表(MMSE)评分,包括语言能力、定向力、注意力与计算力、记忆力、回忆能力五个维度]变化。结果磁共振导航组的手术时间及住院时间均短于电生理导航组[(208±19)min比(243±36)min、(8.9±0.4)d比(9.7±0.7)d](P<0.01),肿瘤切除情况优于电生理导航组(P<0.05)。两组均无手术死亡病例,且术后临床表现均有改善;术后两组的新发癫痫发生率比较差异无统计学意义(P>0.05)。SS、NT、OT、β-ET、AVP水平组间、时点间的主效应差异有统计学意义(P<0.05),组间与时点间存在交互作用(P<0.01)。术后6个月,两组的SS、NT水平较术前升高,且磁共振导航组高于电生理导航组(P<0.05);OT、β-ET、AVP水平较术前降低,但磁共振导航组高于电生理导航组(P<0.05)。MMSE中语言能力、定向力、注意力与计算力、记忆力、回忆能力五个维度评分组间、时点间的主效应差异有统计学意义(P<0.05),组间与时点间存在交互作用(P<0.01)。术后6个月,两组MMSE中各维度评分均较术前升高,且磁共振导航组高于电生理导航组(P<0.05)。结论在岛叶脑胶质瘤显微镜下切除术中,应用MRI辅助神经导航技术对改善患者临床症状与神经电生理技术辅助神经导航技术相当,且能缩短手术及住院时间,改善肿瘤切除情况、神经肽水平及认知功能。

Objective To study the effects of different neuronavigation aids during microscopic resection of insular glioma on the resection effect,neuropeptide levels and postoperative cognitive function.Methods A total of 69 patients with insular glioma treated by microscopic resection in Nanchong Central Hospital from Mar.2016 to Mar.2021 were included,and they were divided according to the different assistive techniques of neuronavigation technology into an electrophysiological navigation group(33 cases,using neuroelectrophysiological technology combined with neuronavigation technology to assist microsurgery)and a magnetic resonance navigation group[36 cases,using magnetic resonance imaging(MRI)combined with neuronavigation technology to assist microsurger].The perioperative indicators(operation time,hospitalization time),tumor resection result,postoperative conditions(clinical manifestation,new epilepsy incidence),neuropeptide[somatostatin(SS),neurotensin(NT),oxytocin(OT),β-endorphin(β-EP),arginine vasopressin(AVP)]level and cognitive function[mini-mental state examination(MMSE)score,including five dimensions of language ability,orientation,attention and computation,memory and recall]of the two groups were compared.Results The operation time and hospitalization time of the magnetic resonance navigation group were shorter than those of the electrophysiological navigation group[(208±19)min vs(243±36)min,(8.9±0.4)d vs(9.7±0.7)d](P<0.01),and the tumor resection result was better than that of the electrophysiological navigation group(P<0.05).There were no surgical deaths in either groups,and the clinical manifestations of both groups were improved.There was no significant difference in the incidence of new epilepsy between the two groups(P>0.05).There were significant differences in the main effect of SS,NT,OT,β-ET and AVP levels between groups and time points(P<0.05),and there were interactions between groups and time points(P<0.01).At 6 months after operation,the levels of SS and NT in the two groups were higher than those before the operation,and the magnetic resonance navigation group was higher than the electrophysiological navigation group(P<0.05);the levels of OT,β-ET,and AVP in the two groups were lower than before operation(P<0.05),but the magnetic resonance navigation group was higher than the electrophysiological navigation group(P<0.05).In MMSE,there were significant differences in the main effects between groups and time points in the five dimensions of language ability,orientation,attention and calculation,memory and recall ability(P<0.05),and there were interactions between groups and time points(P<0.01).At 6 months after operation,the scores of each dimension in the MMSE scale of the two groups were higher than the preoperative(P<0.05),and the magnetic resonance navigation group was higher than the electrophysiological navigation group(P<0.05).Conclusion In the microscopical resection of insular glioma,the application of MRI assisted neuronavigation can improve the clinical symptoms of the patients,which is equivalent to neuroelectrophysiology assisted neuronavigation,and can shorten the operation and hospitalization time,improve the tumor resection result,neuropeptide level and cognitive function.