Background: Glioma is one of the most common intracranial tumors, the treatment for which is surgical resection. Cerebral gliomas in eloquent brain areas are closely associated with important structures. The deep loca...Background: Glioma is one of the most common intracranial tumors, the treatment for which is surgical resection. Cerebral gliomas in eloquent brain areas are closely associated with important structures. The deep location of such gliomas renders complete resection difficult overlaying structures can be injured, causing hemiplegia, aphasia, coma, and other severe complications. The degree of resection directly influences the prognosis of patients. The application of neuronavigation enables the accurate localization of lesions during surgery, significantly improving microneurosurgery. The accuracy of navigation, however, has typically been compromised by several factors, including operation error, shifting of registration system, and intraoperative brain tissue deformation (brain shift). Aim of Study: The aim of the study is to evaluate and demonstrate the efficacy of neuronavigation in the management of brain gliomas. Patients and Methods: This is a prospective randomized clinical trial study included 35 patients with brain glioma were operated for excision or biopsy taken. Results: Localization of burr hole and craniotomy flap was excellent in 33 patients (94.2%) and fault in 2 cases (5.7%), 29 patients (82.8%) had near total excision of the lesions, and 6 patients (17.1%) had burr hole biopsy, intra operative course was smooth in 33 patients (94.2%) with no intra operative complications, 2 cases (5.7%) developed intra operative bleeding that was due to liver problems. Reading the post operative imaging shows that 27 patients (77.1%) had mild to moderate post operative edema around the site of the lesion, the other eight cases were free of hemorrhage, infarction or edema. Conclusion: We found that neuronavigation is very helpful in our cases in localization of the lesions, decreasing time of surgery, reducing morbidity and mortality and decreasing hospital stay. There are concerns about navigation systems including time consuming, calculation and registration, restriction of space and view inside the operating field, and so on, we didn’t find these issues as obstacles in our work, but we found that there are many advantages that can be helpful in the process of operation.展开更多
In order to evaluate the effectiveness ofneuronavigator-guided microsurgery and keyhole technique for the resection of gliomas, a total of 60 patients with gliomas were exactly located by using neuronavigator during m...In order to evaluate the effectiveness ofneuronavigator-guided microsurgery and keyhole technique for the resection of gliomas, a total of 60 patients with gliomas were exactly located by using neuronavigator during microsurgery. Forty deep-seated gliomas were resected through a keyhole operative approach. Thirty out of the 60 cases were subjected to photodynamic therapy （PDT） after tumor resection. The therapeutic effectiveness of all the cases was recorded and analyzed. The resuits showed that glioma was totally resected in 52 cases （86.7%）, subtotally in 5 （8.3%）, and most partially in 3 （5%）. Neurological deficits occurred postoperatively in 4 cases. One patient died of multiple system organ failure 4 days after operation. It was concluded that the application of minimally invasive technique could dramatically decrease surgical complications following resection of glioma, and its combination with PDT could obviously improve the quality of life of patients and prolong the survival time.展开更多
背景甲基化CpG结合蛋白2(methyl-CpG-binding protein 2,MeCP2)在基因转录调控中发挥重要作用,研究表明MeCP2可能是胶质瘤治疗的一个新靶点,但其在胶质瘤中的表达与患者预后的关系尚不清楚。目的探讨MeCP2在胶质瘤中的表达与患者手术后...背景甲基化CpG结合蛋白2(methyl-CpG-binding protein 2,MeCP2)在基因转录调控中发挥重要作用,研究表明MeCP2可能是胶质瘤治疗的一个新靶点,但其在胶质瘤中的表达与患者预后的关系尚不清楚。目的探讨MeCP2在胶质瘤中的表达与患者手术后临床预后的关系。方法选择2016年1月—2018年10月在贵阳市第二人民医院神经外科手术治疗的临床病理资料完整的96例胶质瘤患者,应用免疫组织化学方法检测肿瘤组织和正常脑组织中MeCP2的表达,随访患者生存情况。采用Kaplan-Meier法进行生存分析;采用Cox单因素和多因素风险回归模型分析MeCP2表达水平及相关临床病理因素与患者生存预后的关系。结果96例患者获得随访,其中男51例,女45例,年龄7~79岁,平均年龄(44.9±18.3)岁。免疫组化结果显示胶质瘤组织中MeCP2阳性表达率高于正常脑组织(75.0%vs 30.0%,P<0.05)。MeCP2表达的阳性率在WHOⅠ~Ⅳ级胶质瘤组织中分别为20.0%、66.7%、75.0%、90.6%(1/5、18/27、24/32、29/32),在高级别胶质瘤(WHOⅢ、Ⅳ级)中的阳性表达率高于低级别胶质瘤(WHOⅠ、Ⅱ级),差异有统计学意义(P<0.05)。70例出现肿瘤复发,59例死亡,中位无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)分别为(10.7±1.7)个月和(24.1±2.9)个月。Kaplan-Meier生存分析显示,胶质瘤患者中MeCP2高表达组的中位PFS和OS显著低于低表达组[PFS:(15.6±1.8)个月vs(28.0±2.6)个月,P=0.026;OS:(16.1±2.0)个月vs(28.3±5.8)个月,P=0.022]。Cox回归分析显示,MeCP2高表达(HR:1.705,95%CI:1.019~2.854)、肿瘤病变多发(HR:2.727,95%CI:1.453~5.120)、单纯采用手术治疗(HR:1.704,95%CI:1.015~2.861)、高病理级别(WHOⅢ、Ⅳ级)(HR:3.294,95%CI:2.317~4.683)是胶质瘤患者预后不良的独立危险因素。结论MeCP2在胶质瘤手术患者中表达水平上调,且高表达水平与胶质瘤患者术后不良预后相关。展开更多
Objective To investigate the clinical characteristics, operative methods, and diffusion tensor imaging （DTI） in tile resection of intrinsic insular gliomas via transsylvian approach. Methods From June 2008 to June 2...Objective To investigate the clinical characteristics, operative methods, and diffusion tensor imaging （DTI） in tile resection of intrinsic insular gliomas via transsylvian approach. Methods From June 2008 to June 2010, 12 patients with intrinsic insular gliomas were treated via transsylvian microsurgical approach, with preoperative magnetic resonance imaging diffusion tensor imaging （MR DTI） evaluation. The data of these patients were retrospectively analyzed. Results All patients had astrocytoma, including 8 patients of Grades 1 to II, 2 patients of Grades III to IV, and 2 patients of mixed glial tumors. The insular tumors were completely removed in 9 patients, whereas they were only partially removed from 3 patients. No death was related to the operations. Two patients had transient aphasia, 2 experienced worsened hemiplegia on opposite sides of their bodies, and 2 had mild hemiplegia and language function disturbance. Conclusions Most of tile insular gliomas are of low grade. By evaluating the damage of the corticospinal tract through DTI and using ultrasonography to locate the tumors during operation, microsurgery treatment removes the lesions as much as possible, protects the surrounding areas, reduces the mobility rate, and improves the postoperative quality of life.展开更多
文摘Background: Glioma is one of the most common intracranial tumors, the treatment for which is surgical resection. Cerebral gliomas in eloquent brain areas are closely associated with important structures. The deep location of such gliomas renders complete resection difficult overlaying structures can be injured, causing hemiplegia, aphasia, coma, and other severe complications. The degree of resection directly influences the prognosis of patients. The application of neuronavigation enables the accurate localization of lesions during surgery, significantly improving microneurosurgery. The accuracy of navigation, however, has typically been compromised by several factors, including operation error, shifting of registration system, and intraoperative brain tissue deformation (brain shift). Aim of Study: The aim of the study is to evaluate and demonstrate the efficacy of neuronavigation in the management of brain gliomas. Patients and Methods: This is a prospective randomized clinical trial study included 35 patients with brain glioma were operated for excision or biopsy taken. Results: Localization of burr hole and craniotomy flap was excellent in 33 patients (94.2%) and fault in 2 cases (5.7%), 29 patients (82.8%) had near total excision of the lesions, and 6 patients (17.1%) had burr hole biopsy, intra operative course was smooth in 33 patients (94.2%) with no intra operative complications, 2 cases (5.7%) developed intra operative bleeding that was due to liver problems. Reading the post operative imaging shows that 27 patients (77.1%) had mild to moderate post operative edema around the site of the lesion, the other eight cases were free of hemorrhage, infarction or edema. Conclusion: We found that neuronavigation is very helpful in our cases in localization of the lesions, decreasing time of surgery, reducing morbidity and mortality and decreasing hospital stay. There are concerns about navigation systems including time consuming, calculation and registration, restriction of space and view inside the operating field, and so on, we didn’t find these issues as obstacles in our work, but we found that there are many advantages that can be helpful in the process of operation.
文摘In order to evaluate the effectiveness ofneuronavigator-guided microsurgery and keyhole technique for the resection of gliomas, a total of 60 patients with gliomas were exactly located by using neuronavigator during microsurgery. Forty deep-seated gliomas were resected through a keyhole operative approach. Thirty out of the 60 cases were subjected to photodynamic therapy （PDT） after tumor resection. The therapeutic effectiveness of all the cases was recorded and analyzed. The resuits showed that glioma was totally resected in 52 cases （86.7%）, subtotally in 5 （8.3%）, and most partially in 3 （5%）. Neurological deficits occurred postoperatively in 4 cases. One patient died of multiple system organ failure 4 days after operation. It was concluded that the application of minimally invasive technique could dramatically decrease surgical complications following resection of glioma, and its combination with PDT could obviously improve the quality of life of patients and prolong the survival time.
文摘Objective To investigate the clinical characteristics, operative methods, and diffusion tensor imaging （DTI） in tile resection of intrinsic insular gliomas via transsylvian approach. Methods From June 2008 to June 2010, 12 patients with intrinsic insular gliomas were treated via transsylvian microsurgical approach, with preoperative magnetic resonance imaging diffusion tensor imaging （MR DTI） evaluation. The data of these patients were retrospectively analyzed. Results All patients had astrocytoma, including 8 patients of Grades 1 to II, 2 patients of Grades III to IV, and 2 patients of mixed glial tumors. The insular tumors were completely removed in 9 patients, whereas they were only partially removed from 3 patients. No death was related to the operations. Two patients had transient aphasia, 2 experienced worsened hemiplegia on opposite sides of their bodies, and 2 had mild hemiplegia and language function disturbance. Conclusions Most of tile insular gliomas are of low grade. By evaluating the damage of the corticospinal tract through DTI and using ultrasonography to locate the tumors during operation, microsurgery treatment removes the lesions as much as possible, protects the surrounding areas, reduces the mobility rate, and improves the postoperative quality of life.
