Ohki Masato, Sakurada Kaori, Sonoda Yukihiko, Sato Shinya, Saito Shinjiro, Kayama Takamasa
Department of Neurosurgery, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
Neurosurg Rev. 2003 Oct;26(4):262-5. doi: 10.1007/s10143-003-0280-y. Epub 2003 Jun 19.
One of the most important prognostic factors in brain tumours is the extent of tumour resection. Its evaluation has been difficult on computed tomography (CT); however, magnetic resonance imaging (MRI) can clearly determine the extent of tumour resection. Using MRI, we analyzed 77 patients with astrocytic tumours that were surgically treated at our department from 1994 to 2001. The tumours were classified into the following types: (a) well-circumscribed: single lesions that can be distinguished from normal brain; (b) localised: single lesions that are localised in one gyrus; and (c) diffuse: other tumours. Our treatment of glioma resection is to use sulcus opening and gyrectomy, a technique based on identification and dissection of the sulcus adjacent to the tumour followed by en bloc tumour resection. Almost total tumour resection (> or =95% resection) was achieved in 76.8% in the well-circumscribed type, 100% in the localised type, and only 10.5% in the diffuse type. Nearly total resection was achieved in 61%, which is considerably more than in the literature of the CT era (10.4-23.5%). The sulcus opening and gyrectomy technique based on MRI achieved radical glioma removal in cases which could be identified by MRI, resulting in a better tumour removal rate than that based on CT.
脑肿瘤最重要的预后因素之一是肿瘤切除程度。在计算机断层扫描（CT）上对其进行评估一直很困难；然而，磁共振成像（MRI）能够清楚地确定肿瘤切除程度。我们利用MRI分析了1994年至2001年在我科接受手术治疗的77例星形细胞瘤患者。这些肿瘤被分为以下类型：（a）边界清楚型：可与正常脑组织区分的单个病灶；（b）局限型：局限于一个脑回的单个病灶；（c）弥漫型：其他肿瘤。我们的胶质瘤切除治疗方法是采用脑沟开放和脑回切除术，该技术基于对肿瘤相邻脑沟的识别和分离，然后整块切除肿瘤。边界清楚型肿瘤的几乎全切除（切除率≥95%）达到76.8%，局限型为100%，而弥漫型仅为10.5%。近全切除率达到61%，明显高于CT时代的文献报道（10.4 - 23.5%）。基于MRI的脑沟开放和脑回切除术在MRI能够识别的病例中实现了胶质瘤的根治性切除，其肿瘤切除率高于基于CT的方法。
