术中磁共振成像及多模态导航在胶质母细胞瘤手术切除中的应用

[Application of intraoperative magnetic resonance imaging and multimodal navigation in surgical resection of glioblastoma].

作者信息

Li Fang-Ye, Chen Xiao-Lei, Sai Xiao-Yong, Zhang Jia-Shu, Hu Shen, Li Jin-Jiang, Zheng Gang, Zhang Ting, Li Ye, Hou Meng-Zhuo, Xu Bai-Nan

机构信息

Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2013 Jun 1;51(6):542-6.

PMID:24091271

Abstract

OBJECTIVE

To evaluate the efficacy of intraoperative magnetic resonance imaging (iMRI) and multimodal navigation in surgical resection of glioblastoma.

METHODS

Between February 2009 and July 2010, 76 glioblastoma patients underwent surgical resection guided by iMRI and multimodal navigation. The cohort consisted of 43 male and 33 female patients, with a mean age of 49 years (range: 14-79 years). Rates of gross total resection (GTR) and extent of resection (EoR) were calculated at first and final iMRI scans.Pearson χ(2) test was used to compare the rates of GTR.

RESULTS

iMRI and multimodal navigation were successfully implemented in all cases. Rates of GTR were misestimated by neurosurgeons in 24 cases (31.6%), which were confirmed by first iMRI. Total tumor resection were achieved in 20 cases (26.3%) as a result of iMRI scan, increasing the rates of gross total resection from 52.6% to 78.9% (χ(2) = 11.692, P = 0.001). Extent of resection in 28 patients who underwent further tumor resection were increased from 81.5% to 98.1%, leading to the overall extent of resection improved from 92.3% to 98.4%. At 3-month follow-up, 3 cases (3.9%) developed permanent neurologic deficits. The mean clinical follow-up was 15.6 months (range 3.0-45.0 months). The 2-year overall survival rate was 19.7%. The median progression-free survival of gross total resection group was 12 months (95% CI: 10.1-13.9 months), compared with 9 months (95%CI: 7.9-10.1 months) of the subtotal resection group (χ(2) = 4.756, P = 0.029). The overall survival of gross total resection group was 16 months (95% CI: 13.7-18.3 months), compared with 12 months (95% CI: 9.7-14.3 months) of the subtotal resection group (χ(2) = 7.885, P = 0.005).

CONCLUSION

Combined with multimodal navigation, iMRI helps maximize surgical resection of glioblastoma, preserving neurological function while increasing progression-free survival and overall survival.

摘要

目的

评估术中磁共振成像（iMRI）及多模态导航在胶质母细胞瘤手术切除中的疗效。

方法

2009年2月至2010年7月期间，76例胶质母细胞瘤患者在iMRI及多模态导航引导下接受手术切除。该队列包括43例男性和33例女性患者，平均年龄49岁（范围：14 - 79岁）。在首次及末次iMRI扫描时计算全切除率（GTR）和切除范围（EoR）。采用Pearson χ(2)检验比较GTR率。

结果

所有病例均成功实施iMRI及多模态导航。24例（31.6%）病例中神经外科医生对GTR率估计错误，首次iMRI证实了这一点。iMRI扫描使20例（26.3%）实现了肿瘤全切，全切除率从52.6%提高到78.9%（χ(2) = 11.692，P = 0.001）。28例接受进一步肿瘤切除患者的切除范围从81.5%提高到98.1%，使总体切除范围从92.3%提高到98.4%。在3个月随访时，3例（3.9%）出现永久性神经功能缺损。平均临床随访时间为15.6个月（范围3.0 - 45.0个月）。2年总生存率为19.7%。全切组的无进展生存期中位数为12个月（95%CI：10.1 - 13.9个月），而次全切组为9个月（95%CI：7.9 - 10.1个月）（χ(2) = 4.756，P = 0.029）。全切组的总生存期为16个月（95%CI：13.7 - 18.3个月），而次全切组为12个月（95%CI：9.7 - 14.3个月）（χ(2) = 7.885，P = 0.005）。