术中高场磁共振成像联合功能神经导航在累及视辐射的低级别颞叶肿瘤切除术中的应用

[Intraoperative high-field magnetic resonance imaging combined with functional neuronavigation in resection of low-grade temporal lobe tumors involving optic radiation].

作者信息

Bai Shaocong, Chen Xiaolei, Geng Jiefeng, Wu Dongdong, Yu Xinguang, Xu Bainan

机构信息

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

Department of Neurosurgery, People's Liberation Army General Hospital, Beijing 100853, China; Email:

出版信息

Zhonghua Wai Ke Za Zhi. 2015 May;53(5):340-4.

PMID:26082247

Abstract

OBJECTIVE

To investigate the clinical value of high-field-strength intraoperative magnetic resonance imaging (iMRI) combined with optic radiation neuro-navigation for the resection of temporal lobe low-grade gliomas.

METHODS

From April 2009 to September 2013, 65 patients with temporal lobe low-grade gliomas (WHO grade II) involving optic radiation were operated with iMRI and functional neuro-navigation. Diffusion tensor imaging (DTI) based fiber tracking was used to delineate optic radiation. The reconstructed optic radiations were integrated into a navigation system, in order to achieve intraoperative microscopic-based functional neuro-navigation. iMRI was used to update the images for both optic radiations and residual tumors. Volumetric analyses were performed using 3D Slicer for pre- and intra-operative tumor volumes in all cases. All patients were evaluated for visual field deficits preoperatively and postoperatively. The Student t test was used to evaluate the average rate of extent of resection between groups. Spearman rank correlation analysis was used to assess correlations between predictors and epilepsy prognosis.

RESULTS

Preoperative tumor volumes were (78±40) cm3. In 29 cases, iMRI scan detected residual tumor that could be further resected, and extent of resection were increased from 76.2% to 92.7% (t=7.314, P<0.01). In 19 cases (29.2%), gross total resection was accomplished, and iMRI contributed directly to 8 of these cases. Postsurgical follow-up period varied from 13 months to 59 months, mean (33±13) months. Tumor progression were observed in 3 patients, newly developed or deteriorated visual field defects occurred in 4 patients (6.2%). For patients with pre-operative seizures, Engel Class I were achieved for 89.7% of them. Spearman rank correlation analysis revealed that seizure outcome (Engel Class) was related to increased excision of ratio (r=-0.452, P=0.004, 95% CI: -0.636--0.261) and larger tumors (r=0.391, P=0.014, 95% CI: 0.178-0.484).

CONCLUSIONS

With iMRI and functional neuro-navigation, the optic radiation can be accurately located, while extent of resection can be evaluated intra-operatively. This technique is safe and helpful for preservation of visual field for the resection of temporal lobe low-grade gliomas involving optic radiation.

摘要

目的

探讨高场强术中磁共振成像（iMRI）联合视辐射神经导航在颞叶低级别胶质瘤切除术中的临床应用价值。

方法

2009年4月至2013年9月，65例累及视辐射的颞叶低级别胶质瘤（世界卫生组织二级）患者接受了iMRI和功能神经导航手术。采用基于扩散张量成像（DTI）的纤维追踪技术勾勒视辐射。将重建后的视辐射整合到导航系统中，以实现术中基于显微镜的功能神经导航。iMRI用于对视辐射和残留肿瘤进行图像更新。所有病例均使用3D Slicer软件对术前和术中肿瘤体积进行容积分析。所有患者术前和术后均接受视野缺损评估。采用Student t检验评估组间平均切除率。采用Spearman等级相关分析评估预测因素与癫痫预后的相关性。

结果

术前肿瘤体积为（78±40）cm³。29例患者中，iMRI扫描发现可进一步切除的残留肿瘤，切除率从76.2%提高到92.7%（t=7.314，P<0.01）。19例（29.2%）患者实现了肉眼全切，其中8例直接得益于iMRI。术后随访时间为13个月至59个月，平均（33±13）个月。3例患者出现肿瘤进展，4例患者（6.2%）出现新的或恶化的视野缺损。术前有癫痫发作的患者中，89.7%达到Engel I级。Spearman等级相关分析显示，癫痫结局（Engel分级）与切除率增加（r=-0.452，P=0.004，95%CI：-0.636--0.261）和肿瘤较大（r=0.391，P=0.014，95%CI：0.178-0.484）有关。