额极胶质瘤扩大切除方法及疗效分析

目的探讨切除额极胶质瘤的手术方法。方法自2005年4月至2009年5月,对34例额极胶质瘤患者采用扩大切除术。在肿瘤"边界"外2 cm范围内,参照纵裂、侧裂、冠状缝、胼胝体、侧脑室额角、视神经和视交叉等解剖学标志,将肿瘤及周围受侵脑组织一并切除,术后常规放射治疗。结果本组病例术后无严重合并症,无手术死亡。随访时间为9~46个月,平均时间为22个月。癫痫临床缓解率为94.4%(17/18)。低级别胶质瘤24例,无复发,卡氏评分(karnofsky performance scale,KPS)评分为80~100分,平均评分为94.1分。高级别胶质瘤10例,6例复发,其中1例多形胶质母细胞瘤术后17个月死亡,2例间变少突星形细胞瘤分别于术后20和36个月死亡。存活者KPS评分50~100分,平均评分为75.0分。结论参照解剖学标志,在一定范围内扩大切除额极胶质瘤,可以达到在保护重要功能的前提下延长患者生命的目的。

The Surgical Skill and Outcome of Extended Resection of Frontopolar Glioma

Objective To evaluate the surgical skill and outcome of extended resection of frontopolar glioma. Methods From April 2005 to May 2009, extended resection was performed in 34 patients with frontopolar glioma. Within 2 cm limit around the “border” of the tumor, the tumors were totally removed with involved brain tissue. The resection margin was defined by anatomic landmarks such as longitudinal fissure, lateral fissure, coronal suture, corpus callosum, frontal horn of the lateral ventricle, optic nerve and optic chiasm. Radiation therapy was given postoperatively. Results In our series,there was no operative death. No severe complications occurred. The pathological results were 10 low-grade and 24 high-grade glioma. Clinical remission obtained in all patients with headache and 94.4%(17/18) patients had epilepsy. The mean time of follow up was 22 months(9~46 months). There was no recurrence in patients with low grade glioma(n=24, KPS 80~100). 6 recurrences were noted in patients with high grade glioma(n=10). A patient with glioblastoma died of tumor recurrence 17 months after the surgery. Two patients with anaplastic oligoastrocytoma died of tumor recurrence 20 and 36 months after the surgery respectively. KPS was 50~100 in survivors. Conclusion The anatomic landmarks can be used in extended resection of frontopolar glioma. The surgical procedure is safe and reliable. On the premise of preservation of vital functions, the extended resection may prolong life.