Asgari S, Röhrborn H J, Engelhorn T, Stolke D
Department of Neurosurgery, University Hospital, Essen, Germany.
Acta Neurochir (Wien). 2003 Jun;145(6):453-59; discussion 459-60. doi: 10.1007/s00701-003-0035-0.
Growth and expansion of gliomas are highly dependent on vascular neogenesis. An association of microvascular density and tumour energy metabolism is assumed in most human gliomas. The purpose of this investigation was to characterize a series of gliomas by intra-operative near-infrared spectroscopy (NIRS), and to elucidate the relationship between microvascular blood volume (BV), oxygen saturation (SaO(2)), histology and patient survival.
The study included 13 patients with gliomas, in whom complete tumour resection according to postoperative magnetic resonance imaging criteria was achieved. Intra-operatively, one low grade astrocytoma, five anaplastic astrocytomas and seven glioblastomas with the ipsilateral cortex were investigated by NIRS revealing capillary BV (total haemoglobin) and SaO(2). Intratumoural BV (tBV) and SaO(2) (tSaO(2)) were additionally used in relation to histology and survival.
The mean tBV of the astrocytomas was 4.96 mg/ml compared to 18.40 mg/ml in the glioblastoma group. Mean tSaO(2) was 36% in the astrocytoma group and 52% in the glioblastomas, respectively. Both tBV and tSaO(2) were significantly higher (p<0.01) in the glioblastoma group. Median survival time was shortest for patients with glioblastoma (12.5 months), with tBV >10/mg/ml (10 months), and tSaO(2) >50% (10 months). Longest median survival times were observed in the astrocytoma group (32.5 months), in patients with Tbv <10/mg/ml (30 months), and tSaO(2) <50% (27.5 months). The differences were highly significant (p<0.01).
Intra-operative characterization of gliomas by NIRS is feasible. High tBV represents extensive angiogenetic activity of the tumour, whereas high tSaO(2) may be result of non-oxidative glucose metabolism with less oxygen extraction from the capillary bed of the tumour. However, the extent of tBV and tSaO(2) are both of possible prognostic value thus resulting in additional information about the tumour.
胶质瘤的生长和扩张高度依赖于血管新生。大多数人类胶质瘤中都假定微血管密度与肿瘤能量代谢存在关联。本研究的目的是通过术中近红外光谱（NIRS）对一系列胶质瘤进行特征描述，并阐明微血管血容量（BV）、氧饱和度（SaO₂）、组织学与患者生存率之间的关系。
该研究纳入了13例胶质瘤患者，根据术后磁共振成像标准实现了肿瘤的完整切除。术中，通过NIRS对1例低级别星形细胞瘤、5例间变性星形细胞瘤和7例伴有同侧皮质的胶质母细胞瘤进行了研究，以揭示毛细血管BV（总血红蛋白）和SaO₂。还将肿瘤内BV（tBV）和SaO₂（tSaO₂）与组织学和生存率相关联进行分析。
星形细胞瘤的平均tBV为4.96mg/ml，而胶质母细胞瘤组为18.40mg/ml。星形细胞瘤组的平均tSaO₂分别为36%，胶质母细胞瘤组为52%。胶质母细胞瘤组的tBV和tSaO₂均显著更高（p<0.01）。胶质母细胞瘤患者的中位生存时间最短（12.5个月），tBV>10/mg/ml的患者为10个月，tSaO₂>50%的患者为10个月。星形细胞瘤组观察到最长的中位生存时间（32.5个月），tBV<10/mg/ml的患者为30个月，tSaO₂<50%的患者为27.5个月。差异具有高度显著性（p<0.01）。
通过NIRS对胶质瘤进行术中特征描述是可行的。高tBV代表肿瘤广泛的血管生成活性，而高tSaO₂可能是肿瘤毛细血管床氧摄取较少的非氧化葡萄糖代谢的结果。然而，tBV和tSaO₂的程度都可能具有预后价值，从而产生有关肿瘤的额外信息。
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