Watts Colin, Sanai Nader
Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
Barrow Brain Tumor Research Center, Barrow Neurological Institute, Phoenix, AZ, USA.
Handb Clin Neurol. 2016;134:51-69. doi: 10.1016/B978-0-12-802997-8.00004-9.
Neurosurgical intervention remains the first step in effective glioma management. Mounting evidence suggests that cytoreduction for low- and high-grade gliomas is associated with a survival benefit. Beyond conventional neurosurgical principles, an array of techniques have been refined in recent years to maximize the effect of the neurosurgical oncologist and facilitate the impact of subsequent adjuvant therapy. With intraoperative mapping techniques, aggressive microsurgical resection can be safely pursued even when tumors occupy essential functional pathways. Other adjunct techniques, such as intraoperative magnetic resonance imaging, intraoperative ultrasonography, and fluorescence-guided surgery, can be valuable tools to safely reduce the tumor burden of low- and high-grade gliomas. Taken together, this collection of surgical strategies has pushed glioma extent of resection towards the level of cellular resolution.
神经外科干预仍然是有效治疗胶质瘤的第一步。越来越多的证据表明，低级别和高级别胶质瘤的肿瘤细胞减灭与生存获益相关。除了传统的神经外科原则外，近年来一系列技术得到了改进，以最大化神经外科肿瘤学家的治疗效果，并促进后续辅助治疗的影响。借助术中定位技术，即使肿瘤占据重要功能通路，也可以安全地进行积极的显微手术切除。其他辅助技术，如术中磁共振成像、术中超声和荧光引导手术，可能是安全减轻低级别和高级别胶质瘤肿瘤负荷的有价值工具。综上所述，这一系列手术策略已将胶质瘤的切除范围推向细胞分辨率水平。
