Gildenberg P L
Houston Stereotactic Center, TX 77030, USA.
Stereotact Funct Neurosurg. 2000;74(3-4):179-84. doi: 10.1159/000056478.
Stereotactic and image-guided surgery is becoming increasingly important in the management of brain tumors. Although there are several stereotactic modalities that have been reported to be of value, it is the combination of techniques in a multimodality approach that seems to show the most promise. Both frame-based and frameless guidance may facilitate glioma resection, allowing the optimal amount of resection while permitting avoidance of surrounding eloquent areas. Not only does this optimize resection, but leaving a minimal amount of gross tumor may provide a better bed for intracavitary chemotherapy. Deep tumors may be localized and approached through a small channel, and surgical exposure may be minimized to protect uninvolved areas of the brain. There is increasing evidence that patients operated with imaging guidance have a more benign course and more rapid discharge, perhaps with a lower incidence of adverse neurological sequelae. Stereotactic conformal radiotherapy allows a higher tumor dose while sparing uninvolved brain from radiation more efficiently than conventional techniques, and residual tumor may be treated with a boost of stereotactic radiotherapy. Stereotactic instillation of radioisotopes may be used to treat cystic tumors. Stereotactic insertion of cannulae or radioisotope seeds permit efficient brachytherapy. Stereotactic surgery has moved beyond a subspeciality, so that every neurosurgeon might benefit from using stereotactic techniques in brain tumor management.
立体定向和图像引导手术在脑肿瘤的治疗中变得越来越重要。尽管有几种已报道有价值的立体定向方式，但多模态方法中的技术组合似乎最有前景。基于框架和无框架引导都可能有助于胶质瘤切除，既能实现最佳切除量，又能避免损伤周围功能区。这不仅优化了切除效果，而且残留少量肉眼可见肿瘤可为腔内化疗提供更好的基础。深部肿瘤可通过小通道定位并进入，手术暴露可减至最小以保护未受累的脑区。越来越多的证据表明，在影像引导下进行手术的患者病程更良性，出院更快，可能不良神经后遗症的发生率更低。立体定向适形放疗比传统技术能更有效地在给予肿瘤更高剂量的同时，使未受累脑区免受辐射，残留肿瘤可用立体定向放疗追加剂量治疗。放射性同位素的立体定向注入可用于治疗囊性肿瘤。套管或放射性同位素种子的立体定向插入可实现有效的近距离放疗。立体定向手术已不再只是一个亚专业领域，因此每位神经外科医生在脑肿瘤治疗中使用立体定向技术都可能从中受益。
