CT体表定位下显微手术治疗运动区胶质瘤

目的位于大脑运动区的胶质瘤可造成神经功能损害,在施行运动区病灶切除手术时会严重破坏皮层功能,以致发生显著致残性的临床症状,需要进一步完善手术方式,避免医源性损伤,近年来更加强调对病灶手术的精确定位和微创技术,避免损伤大脑皮层重要功能区,减少手术并发症。本研究探讨运动区脑肿瘤的外科治疗方法。方法回顾分析2009年1月～2013年3月,21例运动区脑胶质瘤患者行CT体表定位下显微手术治疗,对手术治疗方法及疗效进行了回顾性分析和总结。结果星形细胞瘤（WHOⅠ级）3例,少支胶质瘤（WHOⅠ级）2例,星形细胞瘤（WHOⅡ级）7例,星形细胞瘤（WHOⅢ-Ⅳ级）9例。术中全切15例,占71.0%；大部分切除6例,占29.0%,无1例患者手术死亡。术后肢体功能障碍较术前减轻7例,不变6例,短期加重而后肢体活动有所恢复的有4例,加重4例。结论运动区脑胶质瘤的外科治疗必须将切除肿瘤与保护脑功能相结合,脑运动区病灶的成功切除有赖于周密的术前精确定位以及术中微创的手术理念和显微手术技巧。

Micro neurosurgery treatment of motor zone glioma with CT localization

Objective Human glioma located in brain motor zone might cause nerve function damage. Motor zone lesion ectomy could severely destroy cortex function. It was needed to consummate surgery method and avoid iatrogenic injury. For the past few years,more emphasise had been put in accurate localization of lesion and micro trauma technique in order to avoid damage of important brain zone and reduce surgery complication. This study aimed to discuss surgical treatment of motor zone glioma. Methods 21 patients from 2009.01 to 2013.03 with motor zone glioma were performed of microneurosurgery with preoperative CT localization.Then we retrospectivly analysed and summarized operation method and therapeutic effect.Results Astrocytoma（WHO I grade）, 3 cases; oligodendroglioma（WHO I）, 2 cases; astrocytoma（WHO II grade）, 7 cases; astrocytoma（WHO Ⅲ-Ⅳ grade）, 9 cases. Complete ectomy of 15 cases（71.0%）; premodinant ectomy of 6 cases（29%）. No one case died of surgery. After the surgery, 7 cases got improvement in limbs function defect; 6 cases had no change; 4 cases improved after a short term exacerbation; 4cases aggravated. Conclusion In surgical treatment of motor zone glioma, we must combine tumor ectomy with brain function protection. Successful ectomy of motor zone lesion depends on precise and accurate CT localization before surgery and micro trauma concept and microsurgery technique during surgery.