Guochen Sun, Xujun Shu, Dongdong Wu, Kai Zhao, Zhe Xue, Gang Cheng, Ling Chen, Jianning Zhang
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引用次数: 0
Abstract
Background and objectives: Maximal and safe removal of insular gliomas by a transinsular cortex approach is challenging. In this article, a new transtemporal isthmus approach to resect insular gliomas is presented.
Methods: We retrospectively examined 53 patients with insular glioma who underwent resection through the temporal isthmus approach using magnetic resonance imaging and functional neuronavigation guidance and intraoperative electrophysiological monitoring. Extent of resection was determined using intraoperative magnetic resonance imaging.
Results: Fifty-three patients were included for analysis, 30 men and 23 women. The median (range) age was 45 (26-70) years. Tumor laterality was left in 22 patients and right in 31. All tumors involved at least zone III or IV (Berger-Sanai classification system), including zones I-IV were involved in 29 (54.7%) and zones III and IV in 17 (32.0%). Among the 37 low-grade gliomas, preoperative median (IQR) volume was 45.7 (31.8, 60.3) cm 3 , and gross total resection was achieved in 24 (64.9%). Among the 16 high-grade gliomas, preoperative median (IQR) volume was 45.3 (40.1, 54.0) cm 3 , and gross total resection was achieved in 14 (87.5%). The median (IQR) extent of resection of the whole group was 100% (89%-100%). The median (IQR) postoperative Karnofsky performance score 3 months after surgery was 90 (80-90). Mean temporal isthmus width was significantly higher in the affected side (involving tumor) than the contralateral one (21.6 vs 11.3 mm; 95% CI: 9.3 to 11.3, P < .01). Muscle strength was grade 4 or higher, and speech was nearly normal in all patients 3 months after surgery.
Conclusion: Insular glioma surgery using the transtemporal isthmus approach can achieve safe and maximum resection. A widened temporal isthmus provides a surgical pathway for transisthmic resection of insular tumor.
背景和目的：采用经岛叶皮质方法最大限度地安全切除岛叶胶质瘤具有挑战性。本文介绍了一种新的经颞峡切除岛状胶质瘤的方法：我们采用磁共振成像和功能神经导航引导以及术中电生理监测，回顾性研究了53例通过颞峡途径进行切除的岛状胶质瘤患者。切除范围通过术中磁共振成像确定：纳入分析的 53 例患者中，男性 30 例，女性 23 例。年龄中位数（范围）为 45（26-70）岁。22名患者的肿瘤偏左，31名患者的肿瘤偏右。所有肿瘤至少涉及 III 区或 IV 区（Berger-Sanai 分类系统），其中 29 例（54.7%）涉及 I-IV 区，17 例（32.0%）涉及 III 区和 IV 区。在37个低级别胶质瘤中，术前体积中位数（IQR）为45.7（31.8，60.3）立方厘米，24个（64.9%）实现了全切。在16例高级别胶质瘤中，术前中位（IQR）体积为45.3（40.1，54.0）立方厘米，14例（87.5%）实现了大体全切除。全组切除范围的中位数（IQR）为100%（89%-100%）。术后 3 个月的 Karnofsky 评分中位数（IQR）为 90（80-90）。患侧（累及肿瘤）的平均颞峡宽度明显高于对侧（21.6 mm vs 11.3 mm; 95% CI: 9.3 to 11.3, P < .01）。所有患者的肌力均达到4级或以上，术后3个月语言能力基本正常：结论：使用跨颞峡部方法进行岛状胶质瘤手术可以实现安全、最大程度的切除。扩大的颞峡部为经颞峡部切除岛状胶质瘤提供了手术途径。
期刊介绍：
Operative Neurosurgery is a bi-monthly, unique publication focusing exclusively on surgical technique and devices, providing practical, skill-enhancing guidance to its readers. Complementing the clinical and research studies published in Neurosurgery, Operative Neurosurgery brings the reader technical material that highlights operative procedures, anatomy, instrumentation, devices, and technology. Operative Neurosurgery is the practical resource for cutting-edge material that brings the surgeon the most up to date literature on operative practice and technique
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