术中超声在脑胶质瘤手术中的应用

脑胶质瘤是起源于脑神经胶质细胞的肿瘤,是最常见的原发性颅内肿瘤。胶质瘤侵袭性强,预后较差。安全范围内最大程度进行肿瘤切除目前公认是胶质瘤手术的金标准。术中超声的应用可以提高肿瘤切除率并最大程度的保护脑功能区。术中超声有多种优势,包括设备价格便宜、体积小、无辐射,可以提供术中实时影像并精准的定位肿瘤的边界和形状,同时可以协助鉴别残余肿瘤且不受脑组织移位的干扰。目前,多种影像新技术已被应用于术中超声的临床实践中,包括超声造影、三维超声、导航超声、超声弹性成像及功能超声等,都可以术中协助术者进行肿瘤切除。本文将对术中超声新进展、术中超声在胶质瘤手术中的作用和不足进行综述。     

术中超声在脑胶质瘤临床诊疗中的应用

脑胶质瘤是颅内最常见的恶性肿瘤,手术切除是胶质瘤主要的治疗手段。术中超声能够提高肿瘤的切除率、实时定位、精确观察肿瘤的大小形态、监测残余肿瘤、解决脑移位的问题,而超声的新技术如超声造影、三维超声、导航超声、功能超声、弹性超声等对于肿瘤的分级、为术者提供精确的手术路径、保护重要的大血管有着极为重要的意义。本文就目前术中超声在脑胶质瘤临床诊疗中的应用作一综述。     

术中超声联合荧光素钠在高级别胶质瘤显微手术中的应用

目的 探讨术中超声联合荧光素钠实时显像方法在高级别胶质瘤显微手术切除中的应用价值。方法 选取28例(观察组)高级别胶质瘤患者,进行荧光素钠染色,根据肿瘤染色后的强弱结合术中超声确定肿瘤边界进行显微切除。选取(对照组)既往28例高级别胶质瘤按照传统方法行显微手术切除的患者,评估2组手术效果。结果 术后复查增强MRI对比术中超声定位准确,显微镜下可见肿瘤能够被荧光素钠染成深染区(黄绿色)、淡染区(淡黄色)及无染色区,恶性程度越高染色越深,患者术中、术后均无荧光素钠过敏及不适反应。观察组患者肿瘤全切率(92.86%)显著高于对照组(71.43%);手术时间及术后住院时间明显少于对照组。观察组患者术后肌力下降4例,明显低于对照组(10例);术后生存质量评分(KPS评分)优于对照组。术后随访6个月,肿瘤复发率观察组低于对照组。以上指标差异均具有统计学意义(P<0.05)。结论 术中超声联合荧光素纳应用于术中可以在术中准确确定肿瘤边界,达到最大限度切除肿瘤,保护正常脑组织,降低术后复发率,延迟术后复发时间,提高患者术后生存质量。     

术中超声引导下岛叶胶质瘤的显微外科手术治疗

目的 探讨超声导航下岛叶胶质瘤显微手术切除的方法。方法 回顾性分析29例岛叶胶质瘤的手术切除效果,对手术入路,手术方法进行分析。结果 所有病例肿瘤均在术中超声导航下经显微外科切除,17例完整切除,12例次全切除是,术后效果良好,没有严重并发症发生。结论 掌握好岛叶胶质瘤的解剖基础,在超声导航下遵循微创切除的原则,岛叶胶质瘤往往有较好的预后。     

术中磁共振实时影像导航手术切除脑胶质瘤:158例临床体会

背景与目的:手术后肿瘤残余是影响胶质瘤患者生存的主要原因之一,应用术中磁共振影像(intraoperative magnetic resonance imaging,iMRI)导航手术,可达到最大程度切除肿瘤和保护神经功能的双重目的。本研究评估iMRI导航手术切除脑胶质瘤的近期临床疗效。方法:2006年3月至2008年6月,158例脑胶质瘤患者接受iMRI神经导航手术。结果:手术总耗时2.5～8.5h(平均5.2±1.5h)。图像质量优144例(91.1%),良9例(5.7%),差5例(3.2%)。iMRI扫描次数2～5次(平均2.5±0.7次),其中3次42例(26.6%),4次15例(9.5%),5次6例(3.2%)。39.9%的脑胶质瘤病例经iMRI发现肿瘤切除范围未达术前计划,仍需进一步切除。术后早期MRI证实肿瘤全切率达90.5%,术后严重致残率6.8%。无iMRI相关不良事件发生。结论:iMRI实时影像导航手术治疗脑胶质瘤安全有效,可实时纠正术中脑移位误差,精确定位脑胶质瘤的影像学边界,定量评估手术切除范围,有效提高肿瘤切除率。     

术中磁共振实时影像导航手术切除脑胶质瘤：158例临床体会

背景与目的：手术后肿瘤残余是影响胶质瘤患者生存的主要原因之一,应用术中磁共振影像（intraopemtive magnetic resonance imagin烁iMRI）导航手术,可达到最大程度切除肿瘤和保护神经功能的双重目的。本研究评估iMPd导航手术切除脑胶质瘤的近期临床疗效。方法：2006年3月至2008年6月,158例脑胶质瘤患者接受iMRI神经导航手术。结果：手术总耗时2．5。8．5h（平均5．2±1．5h）。图像质量优144例（91．1％）,良9例（5．7％）,差5例（3．2％）。iMRI扫描次数2．5次（平均2．5±0．7次）,其中3次42例（26．6％）,4次15例（9．5％）,5次6例（3．2％）。39．9％的脑胶质瘤病例经iMRI发现肿瘤切除范围末达术前计划,仍需进一步切除。术后早期MRI证实肿瘤全切率达90．5％．术后严重致残率6．8％。无iMRI相关不良事件发生。结论：iMRI实时影像导航手术治疗脑胶质瘤安全有效．可实时纠正术中脑移位误差．精确定位脑胶质瘤的影像学边界,定量评估手术切除范围,有效提高肿瘤切除率。     

16例颅内胶质瘤术中超声定位的临床应用价值研究

目的：探讨术中超声在颅内胶质瘤手术定位中的应用价值。方法：使用GE公司生产的LogiqBook和Logiq5Expert高档彩色超声诊断仪,用无菌薄膜包绕高频（10MHz）术中探头,将探头置于大脑实质表面,对16例影像学诊断为颅内胶质瘤的患者实施术中超声定位,确认肿瘤的大小、位置（包括距离脑实质表面的深度）、超声图像特点、血流等信息,为术者提供精确的手术入路和手术方法,并观察术后切除是否完整,以最便捷而准确完整切除肿瘤。结果：16例颅内胶质瘤中8例位于额叶,4例位于顶叶,1例位于额顶枕叶,2例位于松果体及双侧室,1例位于小脑幕上。16例均完整切除肿瘤。结论：术中超声在颅内胶质瘤手术定位中具有重要的临床应用价值,值得推广。     

16例颅内胶质瘤术中超声定位的临床应用价值研究

目的:探讨术中超声在颅内胶质瘤手术定位中的应用价值.方法:使用GE公司生产的Logiq Book和Logiq5 Expert高档彩色超声诊断仪,用无菌薄膜包绕高频(10MHz)术中探头,将探头置于大脑实质表面,对16例影像学诊断为颅内胶质瘤的患者实施术中超声定位,确认肿瘤的大小、位置(包括距离脑实质表面的深度)、超声图像特点、血流等信息,为术者提供精确的手术入路和手术方法,并观察术后切除是否完整,以最便捷而准确完整切除肿瘤.结果:16例颅内胶质瘤中8例位于额叶,4例位于顶叶,1例位于额顶枕叶,2例位于松果体及双侧室,1例位于小脑幕上.16例均完整切除肿瘤.结论:术中超声在颅内胶质瘤手术定位中具有重要的临床应用价值,值得推广.     

术中超声实时定位在颅内局灶性病变切除中的应用

目的:探讨术中超声实时定位在颅内局灶性病变手术中的应用价值.方法:45例颅内局灶性病变患者于术中用超声对病灶进行实时定位引导,明确手术范围和深度.结果:该组患者均于术中超声实时定位下找到病变,可清楚观察脑中线是否移位,脑室有否扩张、受压或变形,肿瘤大小、边界是否清楚,是囊性、实性或混合性,与CT、MRI及手术对照均相符.结论:术中超声实时定位用于颅内局灶性病变的病灶切除与治疗,可缩短手术时间,避开脑内重要结构,减少不必要的脑组织损伤,预防及减轻术后并发症和后遗症,值得推广应用.     

颅内恶性胶质瘤术中放疗(附4例报告)

颅内恶性胶质瘤是一种死亡率高而难以控制的恶性肿瘤,多呈弥漫浸润性生长,手术不易全部切除,术后复发率高。近年来采用术中放疗（Ｉｎｔｒａｏｐｅｒ－ａｔｉｖｅＲａｄｉａｔｉｏｎＴｈｅｒａｐｙＩＯＲＴ）在手术中直视下放置限光筒对准瘤床、残留灶,亚临床灶给于一...     

Application of intraoperative radiotherapy for malignant glioma

Malignant glioma is characterized by rapid tumor cell proliferation and high recurrence risk. In terms of its treatment, the therapeutic effects of maximum resection and postoperative radiotherapy with adjuvant chemotherapy as well as many other new therapeutic techniques such as antiangiogenic therapy and immunotherapy remain poor. Glioma recurrence, especially local recurrence, is an important reason of glioma treatment failure. Intraoperative radiotherapy (IORT) enables exclusion of radiation-sensitive normal tissue from the radiation field in operation and then the application of a single high-dose precision irradiation to the residual tumor or tumor bed. IORT has great application potential in the control of local recurrence of malignant tumors. This paper thus aims to review the current status and prospects of IORT's application in malignant glioma treatment.     

Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance

BACKGROUND: No age-adjusted or histologic-adjusted assessments of the association between extent of resection and risk of either recurrence or death exist for neurosurgical patients who undergo resection of low-grade glioma using intraoperative magnetic resonance image (MRI) guidance. METHODS: The current data included 156 patients who underwent surgical resection of a unifocal, supratentorial, low-grade glioma in the MRI suite at Brigham and Women's Hospital between January 1, 1997, and January 31, 2003. Estimates of disease-free and overall survival probabilities were calculated using Kaplan-Meier methodology. The association between extent of resection and these probabilities was measured using a Cox proportional hazards model. Observed death rates were compared with the expected death rate using age-specific and histologic-specific survival rates obtained from the Surveillance, Epidemiology, and End Results Registry. RESULTS: Patients who underwent subtotal resection were at 1.4 times the risk of disease recurrence (95% confidence interval [95% CI], 0.7-3.1) and at 4.9 times the risk of death (95% CI, 0.61-40.0) relative to patients who underwent gross total resection. The 1-year, 2-year, and 5-year age-adjusted and histologic-adjusted death rates for patients who underwent surgical resection using intraoperative MRI guidance were 1.9% (95% CI, 0.3-4.2%), 3.6% (95% CI, 0.4-6.7%), and 17.6% (95% CI, 5.9-29.3%), respectively: significantly lower than the rates reported using national data bases. CONCLUSIONS: The data from the current study suggested a possible association between surgical resection and survival for neurosurgical patients who underwent surgery for low-grade glioma under intraoperative MRI guidance. Further study within the context of a large, prospective, population-based project will be needed to confirm these findings.     

Three-dimensional ultrasound imaging of breast cancer by a real-time intraoperative navigation system

BACKGROUND: In order to achieve a good cosmetic result without increasing the risk of ipsilateral breast cancer recurrence after breast conserving surgery, it is very important to minimize the resection volume of the breast without compromising the negativity of the surgical margin. For this purpose, it is necessary to obtain precise information on tumor extension. We therefore developed a three-dimensional (3-D) ultrasound navigation system for breast cancer surgery, which can be performed in the operating room just before surgery. METHODS: We obtained 3-D breast tumor images by the 3-D ultrasound navigation system in 40 patients with primary breast cancer (stage 0-II) who underwent mastectomy or breast conserving surgery. The tumor size was measured in a coronal view of the 3-D tumor image and compared with the tumor size obtained from a pathological map of the tumor extension. RESULTS: We obtained 3-D tumor images in 38 patients (success rate=95%). The tumor size in the images showed a very strong correlation with the pathological tumor size (r=0.898). The difference in tumor size between the 3-D images and pathology was less than 1 cm in 29 tumors (76.3%) and less than 2 cm in 36 (94.7%). On the other hand, the difference in tumor size between palpation and pathology was less than 1 cm in 19 out of 38 tumors (50.0%) and less than 2 cm in 29 tumors (76.3%). The absolute difference between the 3-D images and pathology was significantly less than that between palpation and pathology (p=0.0197). CONCLUSIONS: Our 3-D ultrasound navigation system is useful in visualizing breast tumor extension and is more accurate than palpation. The system is expected to be helpful in deciding on the appropriate surgical margin in breast cancer surgery, resulting in a better cosmetic outcome without increasing the risk of surgical margin positivity.