术中超声在脊髓髓内室管膜瘤和星形细胞瘤外科治疗中的应用

目的探讨术中超声在脊髓髓内室管膜瘤和星形细胞瘤显微外科手术中的应用价值。方法回顾性分析2010年1月至2018年5月华中科技大学同济医学院附属同济医院神经外科收治的78例脊髓髓内室管膜瘤和34例脊髓髓内星形细胞瘤患者的临床资料。根据术中是否使用超声辅助,分别将室管膜瘤和星形细胞瘤患者分为超声组(前者44例,后者18例)和对照组(前者34例,后者16例)。对所有患者行门诊或电话随访,通过影像学复查和改良McCormick量表(MMS)分级评估肿瘤复发和脊髓功能恢复情况。分别比较室管膜瘤和星形细胞瘤两组患者的疗效,并评价术中超声对肿瘤完全切除率的评估准确率。结果两组室管膜瘤和星形细胞瘤患者的性别、年龄、首诊症状、MMS分级及肿瘤累及脊髓节段的差异均无统计学意义(均P>0.05),基线资料均基本一致。室管膜瘤的超声组和对照组患者肿瘤完全切除率[分别为97.7%(43/44)、91.2%(31/34)]、术后并发症发生率[分别为8.8%(3/44)、11.8%(4/34)]及术后3个月脊髓功能恢复良好率[分别为36.4%(16/44)、32.4%(11/34)]的差异均无统计学意义(均P>0.05)。超声组和对照组的星形细胞瘤患者术后并发症发生比例(分别为:0/18、2/16)和术后3个月脊髓功能恢复良好比例(分别为:3/18、2/16)的差异均无统计学意义(均P>0.05);但与对照组比较,超声组的肿瘤完全切除比例高[分别为16/18、9/16,P<0.05]、无进展生存期(PFS)长[中位PFS分别为84.0(67.5~100.5)个月、75.0(52.0~98.0)个月,P<0.05]。以增强MRI为标准,术中超声判断室管膜瘤和星形细胞瘤全切除的准确比率分别为97.7%(42/43)、14/16。结论术中超声有助于实时、准确地判断脊髓髓内室管膜瘤和星形细胞瘤的肿瘤切除程度,且对星形细胞瘤的应用价值较大。

Application of intraoperative ultrasound in microsurgical treatment of intramedullary ependymoma and astrocytoma of the spinal cord

Objective To evaluate the role of intraoperative ultrasound(IoUS)in the microsurgical treatment of intramedullary ependymoma and astrocytoma of the spinal cord.Methods A retrospective review was performed on 78 cases of intramedullary ependymoma and 34 cases of intramedullary astrocytoma which were treated microsurgically between January 2010 and May 2018 at Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.All cases of ependymoma or astrocytoma were divided into IoUS group(44 cases of ependymomas,18 cases of astrocytomas)and control group(34 cases of ependymomas,16 cases of astrocytomas)according to whether IoUS was employed during operation.All patients were followed up in the clinic or by telephone to assess tumor recurrence and spinal function recovery by radiographic reexamination and Modified McCormick Scale(MMS),which were then compared between IoUS and control group in ependymomas and astrocytomas,respectively.The accuracy of intraoperative ultrasound in evaluating the gross total resection(GTR)rate was also evaluated.Results No significant differences were observed in age,sex,presenting symptoms,MMS or spinal cord segment of tumor location between IoUS and control groups in ependymoma or astrocytoma(all P>0.05).Compared with control group in ependymoma,the IoUS group had slightly higher GTR rate[97.7%(43/44)vs.91.2%(31/34)],slightly higher rate of good outcomes in terms of spinal function[36.4%(16/44)vs.32.4%(11/34)]and slightly lower incidence of complications[8.8%(3/44)vs.11.8%(4/34)],which,however,were not significantly different(all P>0.05).For astrocytoma,the IoUS group had significantly higher GTR rate[16/18 vs.9/16,P<0.05]and longer median PFS[84.0(67.5-100.5)months vs.75.0(52.0-98.0)months,P<0.05]compared with control group.The IoUS group had slightly higher rate of good outcomes in terms of spinal function[3/18 vs.2/16,P>0.05]and slightly lower incidence of complications[0/18 vs.2/16,P>0.05]compared with control group.However,those differences were not significant(P>0.05).Postoperative enhanced MRI was used as the gold standard for verification of GTR.The accuracy rate of IoUS for prediction of GTR was 97.7%(43/44)in ependymoma and 14/16 in astrocytoma.Conclusion The intraoperative ultrasound technique could facilitate the real-time and accurate judgement of tumor resection extent,which might have greater application value in the astrocytoma.