Roh Tae Hoon, Sung Kyoung Su, Kang Seok-Gu, Moon Ju Hyung, Kim Eui Hyun, Kim Sun Ho, Chang Jong Hee
Yonsei University Graduate School, Seoul, Republic of Korea.
Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
Acta Neurochir (Wien). 2017 Oct;159(10):1947-1954. doi: 10.1007/s00701-017-3293-y. Epub 2017 Aug 16.
Resection of tumors close to the corticospinal tract (CST) carries a high risk of damage to the CST. For cystic tumors, aspirating the cyst before resection may reduce the risk of damage to vital structures. This study evaluated the effectiveness of cyst aspiration, by comparing the results before and after aspiration of diffusion tensor image (DTI) tractography.
This study enrolled 23 patients with large cystic brain tumors (>20 cm) between 2012 and 2016. All underwent magnetic resonance imaging (MRI), including DTI tractography, followed by navigation-guided aspiration of the cyst and subsequent tumor resection via craniotomy. Distances between the tumor margin and CST before and after cyst aspiration, volume reduction, and postoperative outcomes were assessed.
Median tumor volume decreased from 88 cm (range, 25-153) to 29 cm (range, 20-80) and distances between tumor margins and the CST increased from 5.7 mm (range, 0.6-22.0) to 14.8 mm (range, 0.6-41.4) after aspiration. Neurological symptoms of patients immediately improved after cyst aspiration. All patients, except for one with a secondary glioblastoma, underwent gross total resection of the tumor. No neurological deterioration was observed after tumor resection.
Navigation-guided cyst aspiration followed by resection is a useful and safe procedure for brain tumors with large cystic components. Cyst aspiration resulted in expansion of the compressed brain tissue between the tumor margins and vital structures, making maximal safe resection possible.
切除靠近皮质脊髓束（CST）的肿瘤时，CST受损风险很高。对于囊性肿瘤，在切除前抽吸囊肿可能会降低对重要结构的损伤风险。本研究通过比较弥散张量成像（DTI）纤维束成像抽吸前后的结果，评估囊肿抽吸的有效性。
本研究纳入了2012年至2016年间23例大型囊性脑肿瘤（>20 cm）患者。所有患者均接受了磁共振成像（MRI）检查，包括DTI纤维束成像，随后在导航引导下抽吸囊肿，并通过开颅手术进行后续肿瘤切除。评估了囊肿抽吸前后肿瘤边缘与CST之间的距离、体积缩小情况及术后结果。
抽吸后肿瘤体积中位数从88 cm（范围25 - 153）降至29 cm（范围20 - 80），肿瘤边缘与CST之间的距离从5.7 mm（范围0.6 - 22.0）增加至14.8 mm（范围0.6 - 41.4）。囊肿抽吸后患者的神经症状立即改善。除1例继发性胶质母细胞瘤患者外，所有患者均接受了肿瘤全切术。肿瘤切除后未观察到神经功能恶化。
导航引导下先进行囊肿抽吸再行切除，对于具有大囊性成分的脑肿瘤是一种有用且安全的手术方法。囊肿抽吸导致肿瘤边缘与重要结构之间受压脑组织扩张，使最大安全切除成为可能。
