岛叶胶质瘤的显微外科治疗

目的 探讨岛叶胶质瘤的分型及其显微外科治疗。方法 回顾性分析42例岛叶胶质瘤病人的临床资料，根据患者术前MRI平扫+增强扫描显示病变位置将岛叶胶质瘤分为纯岛叶胶质瘤（5例），额叶-岛叶胶质瘤（12例），颞叶-岛叶胶质瘤（16例），额叶-颞叶-岛叶胶质瘤（9例），采用翼点或扩大翼点入路显微手术切除肿瘤。结果 肿瘤全切除23例，次全切除9例，大部分切除10例。无手术死亡病例。术后28例神经功能完好，4例出现新的神经功能障碍，8例神经功能障碍无变化，2例神经功能障碍加重。22例术后随访时间6~15个月，低级别星形细胞全部生存，8例术后复发再次手术，2例星型胶质细胞瘤Ⅳ级患者1年后死亡。结论 术前对岛叶胶质瘤进行分型，有助于定义肿瘤扩展范围及决定手术方式，有助于最大程度地切除肿瘤。

Microsurgical treatment of insular gliomas (report of 42 cases)

Objective To discuss the types and microsurgery of insular gliomas. Methods The clinical data of 42 patients with insular gliomas, who underwent microsurgery through the pterional or amplified pterional approach for the gliomas, were analyzed retrospectively. Of 42 cases of insular gliomas, which were divided into 4 types according to the timorous regions, 6 arose completely from the insular lobes, 12 from the frontoinsular lobes, 15 from the temporoinsular lobes and 9 from the frontotemporoinsular lobes. Results The total resection of the tumors was achieved in 23 patients, subtotal in 9 and mostly in 10. No patients died from the surgery. The neurological function was completely recovered in 28 patients, there were neurological deficits in 4, the preoperative neurological deficits were unchanged in 8 and the preoperative neurological deficit deteriorated in 2. Of 22 patients followed up from 6 to 15 months, 8 were recovered well, 8 underwent surgery again due to the recurrent tumors, 2 had hemiplegia, 2 had aphasia and 2 died 1 year after the surgery. Conclusions The curative effects of microsurgery on the insular glimoas were good. The preoperative type of the insular gliomas according to their regions was helpful to improvement of the prognoses in the patients with insular gliomas.