神经电生理监测与术中彩超辅助下经侧裂显微手术治疗岛叶胶质瘤

目的探讨分析神经电生理监测与术中彩超辅助下经侧裂显微外科手术治疗岛叶胶质瘤的疗效。方法对2015年1月至2018年1月采用神经电生理监测与术中彩超辅助下经侧裂显微外科手术治疗的21例(电生理彩超组)岛叶胶质瘤患者的临床资料进行分析。以2013年1月至2014年12月未采用神经电生理监测及术中彩超且经皮质入路切除的19例岛叶肿瘤患者为对照组。电生理彩超组术中神经电生理实时监测运动、感觉通路的完整性,术中彩超实时定位肿瘤及明确肿瘤切除情况,均采用改良翼点或扩大翼点经侧裂入路显微手术切除肿瘤。结果根据手术前后影像学分析,电生理彩超组手术全切率为66.66%,明显高于对照组(15.79%)。电生理彩超组中4例术后新岀现对侧肢体运动功能障碍,术后1个月有3例完全恢复,1例出现远期运动功能障碍。其中3例术后新出现语言功能障碍,术后1个月2例恢复至术前水平,1例明显好转。术前存在肢体运动感觉障碍和语言功能障碍的患者,术后均有不同程度的好转。结论术中神经电生理监测联合术中彩超经侧裂显微外科手术岛叶胶质瘤,提高了肿瘤手术切除的安全系数和全切率,效果更为理想。且可以在完全切除肿瘤的同时,能有效的保护周围重要结构和血管,减少了术后并发症的发生。

Clinical efficacy of neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach in treatment of insular glioma

Objective To investigate the clinical efficacy of neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach in the treatment of insular glioma.Methods A total of 21 patients with insular glioma who underwent neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach from January 2015 to January 2018 were included in the study as observation group. And 19 patients with insular glioma who underwent microsurgery via cortical approach without neurophysiological monitoring and intraoperative color Doppler ultrasound from January 2013 to December 2014 were selected as control group. For the observation group, intraoperative neuroelectrophysiology was used to monitor the integrity of motor and sensory pathways in real time, and intraoperative color Doppler ultrasound was used to locate tumors in real time and to confirm tumor resection. Microsurgery via lateral fissure approach using modified or extended pterional approach was used to remove tumors.Results According to imaging analysis before and after surgery, the observation group had a significantly higher total resection rate than the control group (66.66% vs 15.79%). In the observation group, four patients had contralateral motor dysfunction after surgery; at one month after surgery, three patients recovered completely and one patient had long-term motor dysfunction. Three patients had language dysfunction after surgery; at one month after surgery, two patients recovered to the preoperative level and one patient improved significantly. The patients with sensorimotor impairment and language dysfunction before surgery had different degrees of improvement after surgery.Conclusions Neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach can increase the safety factor and total resection rate in the treatment of insular glioma and has satisfactory efficacy. And it can effectively protect the surrounding important structures and blood vessels while completely removing tumors and reduce the incidence of postoperative complications.