Coburger Jan, Nabavi Arya, König Ralph, Wirtz Christian Rainer, Pala Andrej
Department of Neurosurgery, University of Ulm, Günzburg, Germany.
Department of Neurosurgery, International Neuroscience Institute Hannover, Hannover, Germany.
Clin Neurol Neurosurg. 2017 Dec;163:133-141. doi: 10.1016/j.clineuro.2017.10.033. Epub 2017 Oct 31.
In glioma surgery, intraoperative imaging is regarded highly valuable to improve extent of resection. Current distribution of intraoperative imaging techniques is largely unknown. Further, controversy exists which method might be most beneficial.
We performed a web-based survey among members of the European Association of Neurological Surgeons(EANS) from April to May 2017. Our questionnaire included intraoperative MRI(iMRI), 5-aminolevulinic acid(5-ALA), intraoperative ultrasound(iUS),Na-Fluorescein and intraoperative CT(iCT). The value of each method in resection of glioblastoma(GB) and low-grade-glioma(LGG) and their role for intraoperative orientation and usability were rated based on Likert-scales from 1(not valuable/important) to 5(very valuable/important). A total score was calculated based on each sub-score. Mann-Whitney-U-test was used to compare ratings of imaging methods.
Among the 310 participants, iMRI and 5-ALA were regarded as the most valuable intraoperative imaging methods in GB-surgery (iMRIvs.5-ALA,p=0.573;mean 4.05(SE0.149)vs.4.22(SE0.216)). Both were considered significantly more valuable than iUS, Na-Fluorescein and iCT(p≤0.001).Compared to all other methods, iMRI received significantly higher ratings for the resection of LGGs (p<0.01,mean 4.21(SE 0.143)) as well as for intraoperative orientation (mean 4.00(SE0.166)).5-ALA was rated highest regarding intraoperative usability (mean 4.07(SE0.082)). iMRI showed the highest total score compared to all other imaging modalities(p<0.001,mean 15.95(SE 0.484)).
iMRI and 5-ALA were rated most valuable for GB-surgery, while only iMRI reached higher ratings in LGG cases. iMRI was the best imaging method for intraoperative orientation as well as the most valuable method in overall rating. Considering the total score, 5-ALA and iUS received similar values and were rated second highest, followed by Na-Fluorescein and iCT.
在胶质瘤手术中，术中成像被认为对提高切除范围非常有价值。目前术中成像技术的分布情况很大程度上未知。此外，对于哪种方法可能最有益存在争议。
我们在2017年4月至5月期间对欧洲神经外科医生协会（EANS）的成员进行了一项基于网络的调查。我们的问卷包括术中磁共振成像（iMRI）、5-氨基乙酰丙酸（5-ALA）、术中超声（iUS）、荧光素钠和术中CT（iCT）。根据李克特量表（从1（无价值/不重要）到5（非常有价值/重要））对每种方法在胶质母细胞瘤（GB）和低级别胶质瘤（LGG）切除中的价值及其在术中定位和可用性方面的作用进行评分。根据每个子评分计算总分。采用曼-惠特尼-U检验比较成像方法的评分。
在310名参与者中，iMRI和5-ALA被认为是GB手术中最有价值的术中成像方法（iMRI对5-ALA，p = 0.573；平均值4.05（标准误0.149）对4.22（标准误0.216））。两者均被认为比iUS、荧光素钠和iCT更有价值（p≤0.001）。与所有其他方法相比，iMRI在LGG切除（p < 0.01，平均值4.21（标准误0.143））以及术中定位（平均值4.00（标准误0.166））方面获得了显著更高的评分。5-ALA在术中可用性方面评分最高（平均值4.07（标准误0.082））。与所有其他成像方式相比，iMRI的总分最高（p < 0.001，平均值15.95（标准误0.484））。
iMRI和5-ALA在GB手术中被评为最有价值，而在LGG病例中只有iMRI获得了更高的评分。iMRI是术中定位的最佳成像方法，也是总体评分中最有价值的方法。考虑总分，5-ALA和iUS获得了相似的值，并列第二高，其次是荧光素钠和iCT。
