Department of Neurosurgery, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA.
Cancer J. 2012 Jan-Feb;18(1):20-5. doi: 10.1097/PPO.0b013e3183243f6e3.
Glioblastoma multiforme is a highly infiltrative tumor that typically has a central region of necrosis surrounded by contrast-enhancing proliferative tumor cells surrounded by diffuse isolated tumor cells that migrate into the brain. The goal of surgery is often directed toward the central necrotic region and the imaging-defined enhancing margin. To limit morbidity from removing functional brain tissue, the infiltrative tumor cells found in surrounding brain are generally not considered part of the surgical target. This is also the site where tumors recur after treatment. It is well accepted by most surgeons and neuro-oncologists that, when possible, aggressive resection of malignant gliomas is the preferred initial step in management. Although there are limited randomized prospective studies that address extent of resection and survival, the benefit of aggressive surgical resection will not be debated in this report. Tumor resection to the maximum extent that is safely possible can decrease tumor burden and thereby enhance the effects of adjuvant therapies, improve symptoms from mass effect, reduce the frequency of seizures, and provide tissue for pathological and genomic studies to better identify and test novel therapy.Surgery for glioblastoma is highly dependent on imaging. Magnetic resonance imaging can provide an anatomic definition of the lesion and functional capacity of critical cortical regions and allow for precise localization within the brain. The common use of stereotactic guidance, intraoperative imaging, functional magnetic resonance imaging, and physiologic monitoring have enhanced the surgeon's ability to achieve aggressive tumor removal while protecting the patient from neurologic impairment. This review will address the use of these techniques as an important first step in managing patients with glioblastoma.
多形性胶质母细胞瘤是一种高度浸润性肿瘤，通常具有中央坏死区，周围环绕着对比增强的增殖性肿瘤细胞，再被弥散孤立的肿瘤细胞包围，这些细胞向大脑中迁移。手术的目的通常是针对中央坏死区和影像学定义的增强边界。为了限制因切除功能性脑组织而导致的发病率，通常不将周围脑组织中发现的浸润性肿瘤细胞视为手术目标的一部分。这也是肿瘤在治疗后复发的部位。大多数外科医生和神经肿瘤学家都普遍认为，在可能的情况下，积极切除恶性胶质瘤是管理的首选初始步骤。尽管有一些有限的随机前瞻性研究涉及切除范围和生存率，但在本报告中不会讨论积极手术切除的益处。尽可能安全地最大限度地切除肿瘤可以减轻肿瘤负担，从而增强辅助治疗的效果，改善因肿块效应引起的症状，减少癫痫发作的频率，并提供组织进行病理和基因组研究，以更好地识别和测试新的治疗方法。胶质母细胞瘤的手术高度依赖于影像学。磁共振成像可以提供病变的解剖定义和关键皮质区域的功能能力，并允许在大脑内进行精确定位。立体定向引导、术中成像、功能磁共振成像和生理监测的广泛应用增强了外科医生在保护患者免受神经损伤的同时实现积极肿瘤切除的能力。这篇综述将讨论这些技术的使用，作为管理胶质母细胞瘤患者的重要第一步。
