DTI对脑深部胶质瘤手术入路设计的临床意义

目的探讨术前DTI检查及脑白质纤维束重建对设计脑深部胶质瘤手术入路的临床意义。方法随机选取脑深部胶质瘤病人60例,30例术前仅行MRI检查作为对照组,根据易达及避开功能区的原则选择手术入路;30例术前行MRI+DTI检查作为DTI组,行脑白质纤维三维重建,明确脑白质纤维束与肿瘤的三维空间结构关系,以避开重要纤维束及功能区的原则设计手术入路;比较两组病人术后1个月KPS评分的差异。结果对照组镜下全切19例,次全切7例,部分切除4例,全切率63.3%;DTI组镜下全切18例,次全切7例,部分切除5例,全切率60.0%。两组镜下全切率比较,差异无统计学意义(P0.05)。对照组KPS评分为(81.67±20.69)分,DTI组KPS评分为(91.67±16.42)分;两组KPS评分比较,差异有统计学意义(P0.05)。结论术前DTI检查及脑白质纤维束重建对设计脑深部胶质瘤手术入路有重要指导意义,起到保护重要白质纤维束和降低病残率的作用。

Clinical significance of diffusion tensor imaging in designing the surgical approach for brain deep glioma

Objective To study the clinical significance of diffusion tensor imaging （DTI） and reconstruction of cerebral white matter fiber tracts in designing the surgical approach for brain deep glioma. Methods Sixty patients with brain deep glioma were selected randomly. MRI scan was performed before surgery in 30 patients who served as the control group and the surgical approach was chosen for reaching the tumor easily and avoiding the brain functional region. Both DTI and MRI scan were performed before surgery in 30 patients who served as the DTI group, and the cerebral white matter fiber tracts were reconstructed and 3-D spatial structure relationship between the fiber tracts and tumor was clear before surgery. Then, the surgical approach was chosen according to the principle of avoiding the important fiber tracts and brain functional region. Furthermore, the KPS scores were compared between two groups one month after surgery. Results There was a total tumor removal under microscope in 19 and 18 patients, subtotal removal in 7 and 7, and partial removal in 4 and 5 in the control group and DTI group respectively. The rate of total removal was 60.0% in the DTI group and 63.3% in the control group. There was no significant difference in the rate of total removal between two groups （P 〉 0.05）. The mean KPS scores of the patients was 91.67 ± 16.42 in the DTI group, which was significantly higher than 81.67 ± 20.69 in the control group （P〈0.05）. Conclusion DTI and reconstruction of fiber tracts of cerebral white matter have important significance in designing the surgical approach for brain deep glioma and play a role in protecting the essential white matter fiber tracts and reducing the disability rate.