Šteňo Andrej, Hollý Vladimír, Mendel Peter, Šteňová Veronika, Petričková Ľubica, Timárová Gabriela, Jezberová Michaela, Belan Víťazoslav, Rychlý Boris, Šurkala Jozef, Šteňo Juraj
Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Limbová 5, 833 05, Bratislava, Slovakia.
Department of Anaesthesiology, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia.
Acta Neurochir (Wien). 2018 Feb;160(2):331-342. doi: 10.1007/s00701-017-3377-8. Epub 2017 Nov 17.
The data showing usefulness of navigated 3D-ultrasound (3DUS) during awake resections of eloquent gliomas are sparse. Results of surgeries performed using 3DUS were never compared to procedures guided by standard neuronavigation. The aim of this work is to assess the effectiveness of 3DUS during awake resections of eloquent low-grade gliomas (LGGs) by comparing surgical results of two series of patients operated on using conventional neuronavigation and using 3DUS. To our knowledge, a similar study is lacking in the literature.
During a 4-year period (September 2006 to August 2010) 21 awake resections of LGGs guided by neuronavigation (series 1, S1) were consecutively performed in Department of Neurosurgery in Bratislava. During another 4-year period (August 2010 to July 2014) 28 awake resections of LGGs guided by 3DUS (series 2, S2) were consecutively conducted. In both patients series, the eloquent cortical and subcortical structures were intraoperatively detected by direct electrical stimulation. Extent of tumor resection (EOR) and functional outcome in both series were compared.
EOR was significantly greater (p = 0.022) in S2 (median = 93.25%; mean = 86.79%), as compared to S1 (median 87.1%; mean = 75.85%). One permanent minor deficit in S1 and 2 minor deficits in S2 occurred, the difference was not significant (p = 0.999).
Our work represents the first study comparing results of surgeries guided by 3DUS versus conventional navigation. The extent of awake resections of eloquent LGG guided by 3DUS was greater comparing to awake resections guided by standard neuronavigation; use of 3DUS had no impact on the number of new permanent deficits.
关于导航三维超声（3DUS）在功能区胶质瘤清醒切除术中作用的数据稀少。使用3DUS进行手术的结果从未与标准神经导航引导的手术进行比较。本研究的目的是通过比较两组分别采用传统神经导航和3DUS进行手术的患者的手术结果，评估3DUS在功能区低级别胶质瘤（LGG）清醒切除术中的有效性。据我们所知，文献中缺乏类似研究。
在4年期间（2006年9月至2010年8月），布拉迪斯拉发神经外科连续进行了21例由神经导航引导的LGG清醒切除术（第1组，S1）。在另一个4年期间（2010年8月至2014年7月），连续进行了28例由3DUS引导的LGG清醒切除术（第2组，S2）。在两组患者中，术中均通过直接电刺激检测功能区皮质和皮质下结构。比较两组的肿瘤切除范围（EOR）和功能结果。
与S1（中位数87.1%；平均值=75.85%）相比，S2的EOR显著更大（p = 0.022）（中位数=93.25%；平均值=86.79%）。S1出现1例永久性轻度功能缺损，S2出现2例轻度功能缺损，差异无统计学意义（p = 0.999）。
我们的研究是第一项比较3DUS引导手术与传统导航手术结果的研究。与标准神经导航引导的清醒切除术相比，3DUS引导的功能区LGG清醒切除术范围更大；使用3DUS对新的永久性功能缺损数量没有影响。
