Pia H W
Acta Neurochir (Wien). 1986;80(1-2):1-11. doi: 10.1007/BF01809550.
The author describes his microsurgical operative technique used since 1980 for gliomatous tumours. Instead of extensive resection and lobectomy, a pergyral or intergyral persulcal approach with partial gyrectomy, interhemispheric, transsylvian and transventricular exposure of the tumour surface were used. The resection of the tumour begins from its centre. In the first phase 1980-1982 bipolar coagulation, micro-sucker and pincer were used, since 1983 tumour resections have been performed with the CO2 and Nd-Yag laser and CUSA. Tumours located in functionally important regions such as the speech area, thalamus, brain stem, etc. could be removed without additional morbidity and there was a rapid improvement in neurological deficits. The early prognosis of patients harbouring these tumours is improved thanks to minimized operative trauma. The quality of life during the recurrence free period is improved and surgery of recurrence is indicated more frequently than in the past. There is no evidence that these techniques influence the length of the total survival. The use of CT and MRI improved the early diagnosis of small tumours and intraparenchymal lesions. This requires exact intraoperative localization and identification of the lesion. The technical aspects of these procedures are described. Thanks to the improvement in operative technique some limitations of surgery such as location, nature of the tumour and the age of the patient have lost much of their importance.
作者描述了自1980年以来用于胶质瘤肿瘤的显微外科手术技术。取代广泛切除和脑叶切除术，采用了脑回间或脑沟间脑沟切开入路，进行部分脑回切除术，通过半球间、经侧裂和经脑室途径暴露肿瘤表面。肿瘤切除从其中心开始。在1980 - 1982年的第一阶段，使用双极电凝、微型吸引器和钳子，自1983年以来，使用二氧化碳和钕 - 钇铝石榴石激光以及超声吸引器进行肿瘤切除。位于功能重要区域如语言区、丘脑、脑干等的肿瘤能够被切除，且无额外的发病率增加，神经功能缺损迅速改善。由于手术创伤最小化，患有这些肿瘤的患者的早期预后得到改善。无复发期的生活质量得到提高，复发时手术的指征比过去更频繁。没有证据表明这些技术会影响总生存期的长短。CT和MRI的使用改善了小肿瘤和脑实质内病变的早期诊断。这需要术中精确的定位和病变的识别。描述了这些手术的技术方面。由于手术技术的改进，一些手术的限制因素，如肿瘤的位置、性质和患者的年龄，已失去了许多重要性。
