Mandonnet Emmanuel, Capelle Laurent, Duffau Hugues
Department of Neurosurgery, Inserm U678, Hôpital de la Salpêtrière, 47-83 Bd de l'hôpital, 75651, Cedex, 13, Paris, France.
J Neurooncol. 2006 Jun;78(2):179-85. doi: 10.1007/s11060-005-9084-y. Epub 2006 Apr 21.
Low grade gliomas are both proliferative and diffusive tumors, as recently modelized. When proliferation is predominant, the tumor is rather bulky and its main locations are the supplementary motor area and the paralimbic system. Diffusion occurs preferentially along white matter tracts. Recent anatomo-functional studies, performed both in vitro and in vivo, have described the fiber tracts centered around the insula. We thus propose to analyze the extension of paralimbic low grade gliomas in terms of invaded subcortical pathways.
We retrospectively reviewed the MRIs of patients followed for a WHO grade II glioma at the Salpêtrière Hospital between 1991 and 2003. We selected patients with tumors centered on the insula and extending in temporal and frontal lobes (Type 2b-2c-3 of Yasargil's classification). We then analyzed on FLAIR sequences the extension (tracked on successive examinations before any treatment) along two main fasciculi in that area: the uncinate and arcuate fasciculi.
A total of 40 patients fulfilled the inclusion criteria. The uncinate fasiculus was invaded in 28 cases, the arcuate fasciculus in 9 cases, and both fasciculi in 3 cases. Longitudinal follow-up was available in 16 cases, and confirmed the preferential extension along these fasciculi.
This kinetic analysis of extension of paralimbic low grade gliomas confirms that these tumors spread along distinct subcortical fasciculi. Due to the functional role of these pathways, this classification could be useful to elaborate therapeutic strategy (prognosis index, pre- and intra-operative neuropsychological testing, functional outcome).
如最近建模所示，低级别胶质瘤兼具增殖性和浸润性。当增殖占主导时，肿瘤体积较大，主要位于辅助运动区和边缘旁系统。浸润优先沿白质束发生。近期在体外和体内进行的解剖功能研究描述了围绕岛叶的纤维束。因此，我们建议从侵袭的皮质下通路角度分析边缘旁低级别胶质瘤的扩展情况。
我们回顾性分析了1991年至2003年间在萨尔佩特里埃医院接受治疗的WHO二级胶质瘤患者的MRI。我们选择了肿瘤以岛叶为中心并延伸至颞叶和额叶的患者（Yasargil分类中的2b-2c-3型）。然后，我们在FLAIR序列上分析了该区域两条主要纤维束（钩束和弓状束）的扩展情况（在任何治疗前的连续检查中追踪）。
共有40例患者符合纳入标准。钩束受侵28例，弓状束受侵9例，两条纤维束均受侵3例。16例患者有纵向随访资料，证实肿瘤优先沿这些纤维束扩展。
这种对边缘旁低级别胶质瘤扩展的动态分析证实，这些肿瘤沿不同的皮质下纤维束扩散。鉴于这些通路的功能作用，这种分类可能有助于制定治疗策略（预后指数、术前和术中神经心理学测试、功能转归）。
