多模态技术在丘脑胶质瘤手术中的应用

Application of multimodal neuronavigation in thalamic glioma surgery

目的探讨多模态技术在丘脑胶质瘤手术中的作用。方法回顾性分析2015年1月至2022年1月苏州大学附属第一医院神经外科采用手术治疗的53例丘脑胶质瘤患者的临床资料。其中11例采用传统显微手术方式(传统手术组);10例采用多模态神经导航联合术中神经电生理监测技术(技术联合组);32例在技术联合组的基础上,采用核团重建技术在术前定位丘脑核团和脑功能区(技术联合+术前定位组)。比较3组患者肿瘤的切除程度、手术时长、术后新增神经功能缺损情况及出院时Karnofsky功能状态评分(KPS)的改善情况。结果传统手术组、技术联合组、技术联合+术前定位组肿瘤全切除的比例分别为3/11、9/10、29/32(90.6%);术后新增神经功能缺损患者的比例分别为6/11、1/10、5/32(15.6%),出院时KPS较术前增加患者的比例分别为1/11、6/10、18/32(56.3%);技术联合组、技术联合+术前定位组与传统手术组比较,上述指标的差异均有统计学意义(均P<0.01),而技术联合组与技术联合+术前定位组的差异均无统计学意义(均P>0.05)。3组手术时长的差异无统计学意义(P=0.930)。结论在显微手术治疗丘脑胶质瘤中联合多模态技术有助于提高肿瘤的切除程度、降低术中神经功能损伤、提高术后KPS。

ObjectiveTo explore the effect of multimodal neuronavigation in thalamic glioma surgery.MethodsA retrospective analysis was conducted on the clinical data of 53 patients with thalamic glioma admitted to the Department of Neurosurgery,the First Affiliated Hospital of Soochow University from January 2015 to January 2022.Among them,11 patients underwent routine operations(traditional surgical group),10 patients were treated with multimodal neuronavigation combined with intraoperative electrophysiological monitoring(combination technique group),and on the basis of the combined technology group,nuclear reconstruction technology were used in 32 cases to locate thalamic nuclei and brain functional areas before surgery(combination technique+preoperative positioning group).The differences in preoperative baseline condition,total tumor resection rate,operation time,new neurological deficits after surgery and the improvement of Karnofsky functional status score(KPS)at discharge were analyzed among the three groups.ResultsThe total tumor resection rate of the traditional surgical group,the combination technique group and the combination technique+preoperative positioning group were 3/11,9/10 and 29/32(90.6%)respectively.The proportion of patients with new neurological deficits after surgery in the traditional surgical group,the combination technique group and the combination technique+preoperative positioning group were 6/11,1/10 and 5/32(15.6%)respectively.The proportion of patients with increased KPS score at discharge in the traditional surgical group,the combination technique group and the combination technique+preoperative positioning group were 1/11,6/10 and 18/32(56.3%)respectively.Compared with the traditional surgical group,both combination technique group and the combination technique+preoperative positioning group had significant differences in the above indicators(all P<0.01).There were no statistically significant difference in the above indicators between the combination technique group and the combination technique+preoperative positioning group(all P>0.05).There was no statistically significant difference in operation time among the three groups(P=0.930).ConclusionUsing the multimodal neuronavigation in thalamic glioma surgery can improve the total tumor resection rate,reduce the neurological deficits and increase the KPS score after surgery.