Ohue Shiro, Kohno Shohei, Inoue Akihiro, Yamashita Daisuke, Matsumoto Shirabe, Suehiro Satoshi, Kumon Yoshiaki, Kikuchi Keiichi, Ohnishi Takanori
Departments of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan,
Neurosurg Rev. 2015 Apr;38(2):293-306; discussion 306-7. doi: 10.1007/s10143-014-0593-z. Epub 2014 Nov 19.
The current optimal surgery for glioblastomas (GBMs) near the pyramidal tract (PT) is to remove as much tumor as possible and to preserve motor function. The purpose of this study is to investigate the usefulness of tractography-integrated navigation-guided fence-post catheter techniques and motor-evoked potentials (MEPs) for preserving postoperative motor function after GBM surgery. We retrospectively examined 49 patients who underwent resection for GBM near the PT. Diffusion tensor (DT) imaging-based tractography of the PT was performed preoperatively and integrated into the navigation system. When possible, silicon catheters were used as "fence-posts" and were inserted along the tumor boundaries, avoiding the PT, before tumor removal using the navigation system (fence-post catheter techniques). Cortical and subcortical MEPs were also monitored during resection of the tumor. Fence-post catheter techniques using a tractography-integrated navigation system were used in 45 of 49 patients. This technique enabled placement of the catheters, avoided the motor pathways, and allowed easier resection of the tumors. Tumors near the PT were resected using subcortical and cortical MEPs. The amplitudes of cortical MEPs after tumor removal were maintained at over 33 % of those obtained before resection. Thirty-six patients showed obvious responses of subcortical MEPs at ≤20 mA. The degree of resection was gross total in 21 patients, subtotal in 21, and partial in seven. One month after surgery, only one patient showed worsened motor function. Therefore, fence-post catheter techniques using a tractography-integrated navigation system and MEPs may contribute to preserving motor function after surgery for GBMs that are near the PT.
目前，针对锥体束（PT）附近的胶质母细胞瘤（GBM），最佳手术方式是尽可能多地切除肿瘤并保留运动功能。本研究旨在探讨磁共振神经成像融合导航引导下的栅栏式导管技术及运动诱发电位（MEP）在GBM手术后保留运动功能方面的作用。我们回顾性研究了49例接受PT附近GBM切除术的患者。术前对PT进行基于扩散张量（DT）成像的磁共振神经成像，并将其整合到导航系统中。在可能的情况下，使用硅导管作为“栅栏”，在利用导航系统切除肿瘤前（栅栏式导管技术），沿肿瘤边界插入，避开PT。在肿瘤切除过程中还监测皮质和皮质下MEP。49例患者中有45例使用了磁共振神经成像融合导航系统的栅栏式导管技术。该技术能够放置导管，避开运动通路，并使肿瘤切除更容易。利用皮质下和皮质MEP切除PT附近的肿瘤。肿瘤切除后皮质MEP的波幅维持在切除前获得波幅的33%以上。36例患者在≤20 mA时皮质下MEP有明显反应。切除程度为全切除21例，次全切除21例，部分切除7例。术后1个月，只有1例患者运动功能恶化。因此，磁共振神经成像融合导航系统的栅栏式导管技术及MEP可能有助于保留PT附近GBM手术后的运动功能。
