Department of Neurological Surgery, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013, USA.
Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, San Francisco, California 94303, USA.
Nat Rev Clin Oncol. 2018 Feb;15(2):112-125. doi: 10.1038/nrclinonc.2017.171. Epub 2017 Nov 21.
Surgical resection remains the mainstay of treatment for patients with glioma of any grade. Maximal resection of the tumour is central to achieving long-term disease control; however, the relationship between the extent of glioma resection and actual clinical benefit for the patient is predicated on the balance between cytoreduction and neurological morbidity. For the neurosurgical oncologist, the clinical rationale for undertaking increasingly extensive resections has gained traction. In parallel, novel surgical techniques and technologies have been developed that help improve patient outcomes. During the past decade, neurosurgeons have leveraged advanced intraoperative imaging methods, fluorescence-based tumour biomarkers, and real-time mutational analyses to maximize the extent of tumour resection. In addition, approaches to minimizing the risk of perioperative morbidity continue to be improved through the combined use of stimulation-mapping techniques, corticospinal tract imaging, and stereotactic thermal ablation. Taken together, these modern principles of neurosurgical oncology bear little resemblance to historical therapeutic strategies for patients with glioma and have dramatically altered the approach to the treatment of patients with these brain tumours. Herein, we outline the state of the art in surgical oncology for gliomas.
手术切除仍然是治疗任何级别的胶质瘤患者的主要方法。最大限度地切除肿瘤是实现长期疾病控制的核心；然而，肿瘤切除的范围与患者的实际临床获益之间的关系，取决于细胞减少和神经发病率之间的平衡。对于神经外科肿瘤医生来说，接受越来越广泛的切除的临床理由已经得到了认可。与此同时，新的手术技术和技术也得到了发展，有助于改善患者的预后。在过去的十年中，神经外科医生利用了先进的术中成像方法、基于荧光的肿瘤生物标志物和实时突变分析，以最大限度地提高肿瘤切除的范围。此外，通过联合使用刺激映射技术、皮质脊髓束成像和立体定向热消融，继续改进最大限度降低围手术期发病率的风险的方法。总的来说，这些神经外科肿瘤学的现代原则与历史上治疗胶质瘤患者的治疗策略几乎没有相似之处，并且极大地改变了治疗这些脑肿瘤患者的方法。在此，我们概述了神经外科肿瘤学治疗胶质瘤的最新进展。
