Bunyaratavej Krishnapundha, Wangsawatwong Piyanat
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand.
Br J Neurosurg. 2019 Oct;33(5):528-535. doi: 10.1080/02688697.2019.1587380. Epub 2019 Mar 12.
: A challenging aspect of glioma surgery is to distinguish tumour tissue from surrounding eloquent structures and perform resection with accuracy. Various technologies have been used to address this issue including neuronavigator, intraoperative magnetic resonant imaging, intraoperative ultrasound, and fluorescence, each of which has certain drawbacks and limitations. In this study, authors demonstrate the technique of using stereotactically placed catheters as guidance during cerebral glioma resection and report the surgical outcomes. : This study included patients with intrinsic cerebral tumour adjacent to the eloquent structures. Catheter trajectories were planned using three-dimensional cerebral reconstruction on navigation software and catheters were stereotactically placed to mark the intended extent of resection. All craniotomies were performed in awake fashion under neurophysiologic mapping and continuous physical examination for safe maximal resection. Clinical outcome and intended versus actual extent of resection were analysed. : Between January 2015 and December 2016, 15 consecutive patients (8 males and 7 females) with intrinsic cerebral tumour underwent craniotomy with this technique. Median age was 43 years. Seven patients (46.7%) had worsening neurological status within 24 h postoperatively. Of these 7 patients, 6 patients (85.7%) regained preoperative neurological status by 6 months. The intended extent of resections were total, subtotal and partial in 3 (20%), 9 (60%), and 3 (20%) patients, respectively. The actual extent of resections were total, subtotal and partial in 3 (20%), 8(53.3%), and 4 (26.7%) patients, respectively. There were no catheter related complications. There was no 30-day postoperative mortality. : Catheter guided resection along with awake surgery and neurophysiologic monitoring is a valid technique for infiltrative tumour, especially for ones locating near eloquent structures where the margin of error is low. This is a simple and economical technique which requires only standard equipment widely available to neurosurgical operating theatres.
胶质瘤手术中一个具有挑战性的方面是将肿瘤组织与周围功能区结构区分开来并精确进行切除。已经使用了各种技术来解决这个问题，包括神经导航、术中磁共振成像、术中超声和荧光技术，每种技术都有一定的缺点和局限性。在本研究中，作者展示了在脑胶质瘤切除术中使用立体定向放置的导管作为引导的技术，并报告了手术结果。
本研究纳入了与功能区结构相邻的脑实质肿瘤患者。使用导航软件上的三维脑重建规划导管轨迹，并通过立体定向放置导管来标记预期的切除范围。所有开颅手术均在清醒状态下进行，同时进行神经生理图谱绘制和持续体格检查，以实现安全的最大程度切除。分析临床结果以及预期与实际切除范围。
在2015年1月至2016年12月期间，15例连续的脑实质肿瘤患者（8例男性和7例女性）接受了采用该技术的开颅手术。中位年龄为43岁。7例患者（46.7%）在术后24小时内神经功能状态恶化。在这7例患者中，6例患者（85.7%）在6个月时恢复到术前神经功能状态。切除的预期范围分别为全切、次全切和部分切除的患者有3例（20%）、9例（60%）和3例（20%）。实际切除范围分别为全切、次全切和部分切除的患者有3例（20%）、8例（53.3%）和4例（26.7%）。没有与导管相关的并发症。术后30天内无死亡病例。
导管引导下切除联合清醒手术和神经生理监测是治疗浸润性肿瘤的一种有效技术，特别是对于位于功能区结构附近、误差范围小的肿瘤。这是一种简单且经济的技术，只需要神经外科手术室广泛配备的标准设备。
