Benveniste Ronald J, Germano Isabelle M
Department of Neurosurgery, Mt. Sinai School of Medicine, New York, NY 10029, USA.
Surg Neurol. 2005 Jun;63(6):542-8; discussion 548-9. doi: 10.1016/j.surneu.2004.11.025.
Intraoperative brain shift may cause inaccuracy of stereotactic image guidance on the basis of preoperatively acquired imaging data. The purpose of our study was to determine whether factors predicting brain shift affect the success of image-guided resection of malignant brain tumors.
We retrospectively studied 54 patients who underwent image-guided resections of histopathologically confirmed malignant brain tumors (9 metastases, 45 high-grade gliomas). Precautions were taken during surgery to minimize brain shift, but intraoperative imaging was not performed. The following factors predictive of intraoperative brain shift were assessed: tumor size, periventricular location, patient age, prior surgery or radiation therapy, patient positioning, use of mannitol, and length of operative time. Postoperative magnetic resonance imaging was obtained in all cases within 48 hours of surgery to assess extent of resection.
Perioperative mortality was 0% in our series; perioperative morbidity was 3 of 54 patients (5.5%); 1 patient required reoperation for a hematoma, and 2 had transient neurological deficits. Successful resection was accomplished in 93% of tumors less than 30 cm(3) compared with 63.6% of tumors greater than 30 cm(3) (P = .026, Fisher exact test). This difference was more pronounced for patients with malignant gliomas. However, other factors predictive of intraoperative brain shift were not associated with unsuccessful resection.
Intraoperative brain shift does not significantly affect the likelihood of successful resection of malignant brain tumors smaller than 30 cm(3). Larger tumors are less likely to be successfully resected, although factors other than brain shift can contribute to unsuccessful resection.
术中脑移位可能导致基于术前采集影像数据的立体定向影像引导出现误差。本研究的目的是确定预测脑移位的因素是否会影响恶性脑肿瘤影像引导下切除术的成功率。
我们回顾性研究了54例接受影像引导下组织病理学确诊为恶性脑肿瘤切除术的患者（9例转移瘤，45例高级别胶质瘤）。手术过程中采取了预防措施以尽量减少脑移位，但未进行术中成像。评估了以下预测术中脑移位的因素：肿瘤大小、脑室周围位置、患者年龄、既往手术或放疗史、患者体位、甘露醇的使用以及手术时间。所有病例均在术后48小时内进行磁共振成像以评估切除范围。
我们系列研究中的围手术期死亡率为0%；54例患者中有3例（5.5%）发生围手术期并发症；1例患者因血肿需要再次手术，2例有短暂神经功能缺损。小于30 cm³的肿瘤93%实现了成功切除，而大于30 cm³的肿瘤这一比例为63.6%（P = 0.026，Fisher精确检验）。这种差异在恶性胶质瘤患者中更为明显。然而，其他预测术中脑移位的因素与切除失败无关。
术中脑移位对小于30 cm³的恶性脑肿瘤成功切除的可能性没有显著影响。较大的肿瘤成功切除的可能性较小，尽管除脑移位外的其他因素也可能导致切除失败。
