术中超声在脑功能区胶质瘤切除术中的应用价值

目的:探讨术中超声(IOUS)在切除脑功能区胶质瘤中的临床价值。方法:回顾性队列研究。纳入2018年12月—2020年6月蚌埠医学院第一附属医院神经外科62例脑功能区胶质瘤患者，其中男26例、女36例，年龄28~68岁；胶质瘤WHO分级Ⅰ级13例、Ⅱ级22例、Ⅲ级21例、Ⅳ级6例。62例患者均行肿瘤开颅显微切除术，根据...

Application value of intraoperative ultrasound in the resection of glioma located in functional cerebral areas

Objective To explore the clinical value of intraoperative ultrasound (IOUS) in the removal of gliomas in the functional areas of the brain.Methods A retrospective cohort study was conducted on 62 patients with gliomas in functional brain areas who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Bengbu Medical College from December 2018 to June 2020. The patients included 26 males and 36 females aged 28-68 years. Among the patients, 13 cases had grade I glioma, 22 cases had grade Ⅱ glioma, 21 cases had grade Ⅲ glioma, and 6 cases had grade Ⅳ glioma based on WHO classification. All patients underwent tumor craniotomy and were divided into two groups according to whether or not ultrasound was used during operation. Thirty-one cases who used IOUS were included in the observation group, and 31 cases who did not use IOUS were included in the control group. The following clinical baseline data of the two groups of patients were compared: the sonographic performance of IOUS on different grades of glioma, the time taken to expose the tumor during the operation, the duration of the operation, the degree of tumor resection, and the degree of brain edema on the 5th day after the operation. Karnofsky performance status (KPS) score was used to evaluate the recovery of neurological function in the two groups at 3 months after surgery.Results The two groups had no statistically significant differences in gender, age, tumor size, tumor location, tumor grade, the vertical distance from the tumor center to the dura mater, the degree of brain edema, and neurological KPS before operation (all P values＞0.05). Different grades of glioma had different sonogram features. The IOUS echo of low-grade glioma a higher than that of brain tissue, the interior was slightly uniform with regular edges, and strong echoes with calcification could be observed inside. High-grade glioma had better IOUS echo than the brain, and the edges were blurred, mixed echo shadows were present, and the necrotic cystic area had non-uniform internal echo or was non-echoic. The observation group had shorter exposure time (23.1±3.7 min), higher degree of tumor resection, lesser degree of brain edema on the 5th postoperative day, and higher 3-month KPS score (78.32±4.32) than the control group (exposure time=37.32±4.32] min, 3-month KPS score=74.22±2.38), and the differences between the groups were statistically significant (all P values＜0.05). The operation time of the observation group (187.4±17.8] min) and control group (194.8±15.8] min) had no statistically significant difference (P＞0.05).Conclusions IOUS is used in microsurgery for the craniotomy of gliomas in functional brain areas. IOUS has the advantage of accurate real-time positioning, which can increase total tumor resection rate, reduce postoperative cerebral edema, and protect and improve postoperative neurological function. Thus, IOUS is worthy of clinical application.