Martynov B V, Kholiavin A I, Parfenov V E, Nizkovolos V B, Trufanov G E, Fokin V A, Dekan V S, Alekseeva N P, Gracheva P V, Kofman A V, Svistov D V
Zh Vopr Neirokhir Im N N Burdenko. 2011;75(4):17-24; discussion 24.
Aim of the study was to evaluate the safety and efficiency of stereotactic cryodestruction of supratentorial astrocytomas that were located deeply in the brain and/or within eloquent areas.We examined 74 patients aged 18-64 years with supratentorial gliomas of different grade located in deep or eloquent brain areas. All the patients underwent stereotactically guided cryodestruction of the tumor. The survival rate was evaluated by the Kaplan-Meier method. The chi-square method was used for comparative analysis of results of this study with available data from the literature. For the analysis of the prognostic importance of various factors the Cox proportional hazards model was applied. The average survival period was 12.4 months for glioblastoma (control group--6.4 months, p=0.04), and 46.9 months for anaplastic astrocytoma (control group--18 months, p=0.006). For patients with fibrillar-protoplastic astrocytoma the 5-year survival rate was 95.7%. The frequencies of complications did not exceed those of the routine surgical interventions in patients with brain tumors. We found that stereotactic cryodestruction as well the Karnofsky performance score were statistically reliable prognostic factors (p=0.0377 and p=0.0006, respectively), while the extent of cryodestruction and the residual tumor mass did not influence the survival rate. Stereotactic cryodestruction is a safe surgical procedure, which results in statistically significant improvement of survival in patients with supratentorial gliomas located within deep and/or eloquent areas of brain.
本研究的目的是评估立体定向冷冻毁损位于脑深部和/或功能区的幕上星形细胞瘤的安全性和有效性。我们检查了74例年龄在18 - 64岁之间、幕上不同分级的胶质瘤位于脑深部或功能区的患者。所有患者均接受了立体定向引导下的肿瘤冷冻毁损术。采用Kaplan-Meier法评估生存率。采用卡方检验法将本研究结果与文献中的现有数据进行比较分析。为分析各种因素的预后重要性，应用Cox比例风险模型。胶质母细胞瘤的平均生存期为12.4个月（对照组为6.4个月，p = 0.04），间变性星形细胞瘤为46.9个月（对照组为18个月，p = 0.006）。纤维型-原浆型星形细胞瘤患者的5年生存率为95.7%。并发症发生率不超过脑肿瘤患者常规手术干预的发生率。我们发现立体定向冷冻毁损以及卡诺夫斯基功能状态评分是具有统计学意义的预后因素（分别为p = 0.0377和p = 0.0006），而冷冻毁损范围和残余肿瘤体积并不影响生存率。立体定向冷冻毁损是一种安全的手术方法，可使位于脑深部和/或功能区的幕上胶质瘤患者的生存率得到统计学上的显著提高。
