复发性胶质瘤的神经导航手术治疗(附28例临床报道)

目的探讨复发性胶质瘤的手术治疗及神经导航系统在手术中的作用。方法总结28例采用神经导航系统进行手术的复发性胶质瘤病人的病例资料。位于大脑半球深部者18例,浅部者8例,位于小脑者2例。手术经原切口进入者20例,改变切口者8例。结果导航平均注册误差小于2 mm。全切除22例(78.6%),次全切除4例(14.3%),大部切除2例(7.1%)。术后症状改善或不变25例(89.3%),加重3例(10.7%)。术后对21例随访6个月,均无复发;17例随访1年,复发2例;9例随访3年,复发5例。结论神经导航系统应用于复发性胶质瘤手术治疗,有助于肿瘤的术中定位和切除范围的实时判断,从而提高肿瘤的全切除率,延缓肿瘤再复发。

Neuronavigation guided surgery for recurrent glioma: report of 28 cases

Objective To discuss the roles of neuronavigation system in surgical treatment of recurrent gliomas. Methods Twenty-eight cases of recurrent gliomas surgically treated with neuronavigation system were analyzed. The locations of lesion included deep part of hemisphere in 18 cases, superficial part of hemisphere in 8, and cerebellum in 2. In terms of operative approach, 20 cases underwent craniotomy through primary approaches and 8 through changed approaches. The significance of navigation system in surgical treatment of recurrent gliomas was evaluated. Results Total removal of the lesion was achieved in 22 cases (78.6%), subtotal removal in 4 (14.3%), and aggressive removal in 2 (7.1%). Postoperative neurological functions were improved or unchanged in 25 cases, and aggravated in 3. After 6 months follow-up period, no tumor recurrence was reported in 21 cases. After 1 year follow-up period, 2 of 17 cases reported tumor recurrences. After 3-year follow-up period, 5 of 9 patients reported tumor recurrences. Mean registration error of the navigation was less than 2mm. Conclusion Neuronavigation system helps to locate tumors intraoperatively, so as to increase total removal rate of lesions, suspend recurrence, and prolong the postoperative survival of patients.