Bykanov A E, Pitskhelauri D I, Pronin I N, Tonoyan A S, Kornienko V N, Zakharova N E, Turkin A M, Sanikidze A Z, Shkarubo M A, Shkatova A M, Shults E I
Burdenko Neurosurgical Institute, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2015;79(3):5-14. doi: 10.17116/neiro20157935-14.
Despite the obvious progress in modern neurosurgery, surgery for glial tumors of the insular lobe is often associated with a high risk of postoperative neurological deficit, which is primarily caused by damage to perforating arteries of the M1 segment of the middle cerebral artery.
The work is aimed at evaluating the effectiveness of high resolution time-of-flight (3D-TOF) MR angiography in imaging of medial and lateral lenticulostriate arteries and determining their relationship to tumor edge in patients with gliomas of the insula.
3D-TOF MR angiography data were analyzed in 20 patients with primarily diagnosed cerebral gliomas involving the insula. All patients underwent non-contrast enhanced 3D-TOF MR angiography. In 6 cases, 3D-TOF MRA was performed before and after contrast enhancement.
3D-TOF angiography before intravenous contrast injection was capable of visualizing the medial lenticulostriate arteries in 19 patients (95% of all cases) and lateral lenticulostriate arteries in 18 patients (90% of all cases). Contrast-enhanced 3D-TOF angiography allows for better visualization of both the proximal and distal segments of lenticulostriate arteries. Three variants of relationship between the tumor and lenticulostriate arteries were identified. Variant I: the tumor grew over the arteries without their displacement in 2 cases (10% of the total number of observations); variant II: the tumor caused medial displacement of arteries without growing over them in 11 cases (55% of the total number of observations); variant III: the tumor partially grew over and displaced arteries in 2 cases (10%). In 25% of cases (5 patients), tumor was poorly visualized on 3D-TOF MR angiograms because their signal characteristics did not differ from those of the medulla (tumor tissue was T1 isointense). As a result, it was impossible to determine the relationship between the tumor and lenticulostriate arteries.
High spatial resolution time-of-flight MR angiography can be recommended for preoperative imaging of lenticulostriate arteries to plan the extent of neurosurgical resection in patients with glial tumors of the insular lobe.
尽管现代神经外科手术取得了显著进展，但岛叶胶质肿瘤手术术后神经功能缺损风险通常较高，这主要是由大脑中动脉M1段穿支动脉受损所致。
本研究旨在评估高分辨率时间飞跃（3D - TOF）磁共振血管造影术在岛叶胶质瘤患者中对内侧和外侧豆纹动脉成像的有效性，并确定它们与肿瘤边缘的关系。
对20例初诊为累及岛叶的脑胶质瘤患者的3D - TOF磁共振血管造影数据进行分析。所有患者均接受了非增强3D - TOF磁共振血管造影。6例患者在增强前后均进行了3D - TOF磁共振血管造影。
静脉注射造影剂前的3D - TOF血管造影能够在19例患者（占所有病例的95%）中显示内侧豆纹动脉，在18例患者（占所有病例的90%）中显示外侧豆纹动脉。增强后的3D - TOF血管造影能更好地显示豆纹动脉的近端和远端节段。确定了肿瘤与豆纹动脉关系的三种变体。变体I：肿瘤在动脉上方生长而未使其移位，共2例（占观察总数的10%）；变体II：肿瘤导致动脉向内侧移位但未在其上方生长，共11例（占观察总数的55%）；变体III：肿瘤部分在动脉上方生长并使其移位，共2例（占10%）。在25%的病例（5例患者）中，肿瘤在3D - TOF磁共振血管造影上显示不佳，因为其信号特征与髓质无差异（肿瘤组织T1等信号）。因此，无法确定肿瘤与豆纹动脉的关系。
对于岛叶胶质肿瘤患者，高空间分辨率时间飞跃磁共振血管造影可用于术前豆纹动脉成像，以规划神经外科切除范围。
