Gassie Kelly, Alvarado-Estrada Keila, Bechtle Perry, Chaichana Kaisorn L
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States.
J Neurol Surg A Cent Eur Neurosurg. 2019 May;80(3):198-204. doi: 10.1055/s-0038-1676575. Epub 2019 Mar 20.
BACKGROUND AND STUDY AIMS/OBJECTIVE: Metastatic brain tumors are the most common type of adult brain tumors. Treatment involves surgery and/or radiation therapy. Surgery is typically reserved for patients with good neurologic function, solitary and accessible lesions, symptomatic lesions, and/or those with good systemic control of their primary cancer. Deep-seated lesions, however, are typically treated with palliative options including radiation and medical therapies. We summarize our personal experience with minimally invasive surgical approaches for these deep-seated metastatic brain tumors using tubular retractors with exoscopic visualization.
Patients with deep-seated metastatic brain tumors who were operated on from January 2016 to December 2017 by the senior author were collected prospectively. "Deep seated" was defined as any subcortical location below the deepest adjacent sulcus in close proximity to the basal ganglia and/or thalamus. "Minimally invasive" was defined as the use of tubular retractors with exoscopic visualization.
A total of 15 consecutive patients with an average ± standard deviation age of 63 ± 12 years underwent surgical resection of a deep-seated metastasis. The tumor was located in the centrum semiovale in seven (47%) (3 corticospinal tract, 2 superior longitudinal fasciculus, 1 visual tract, 1 inferior frontal occipital fasciculus), basal ganglia in three (20%), thalamus in two (13%), and cerebellum in three (20%). Median percentage resection was 100% (interquartile range:100-100%), and, following surgery, seven (47%), seven (47%), and one (7%) had an improved, stable, and worse Karnofsky Performance Score, respectively. No patients had notable local complications including stroke, infection, hemorrhage, and/or seizure. All patients underwent postoperative stereotactic radiosurgery.
This minimally invasive approach can be used to achieve extensive resection with minimal morbidity for arguably the highest risk metastatic brain tumors.
转移性脑肿瘤是成人脑肿瘤中最常见的类型。治疗方法包括手术和/或放射治疗。手术通常适用于神经功能良好、病灶孤立且易于接近、有症状的病灶以及/或原发癌得到良好全身控制的患者。然而，深部病灶通常采用姑息性治疗方法，包括放疗和药物治疗。我们总结了使用带内镜可视化的管状牵开器对这些深部转移性脑肿瘤进行微创手术的个人经验。
前瞻性收集2016年1月至2017年12月由资深作者手术治疗的深部转移性脑肿瘤患者。“深部”定义为紧邻基底神经节和/或丘脑的最深相邻脑沟下方的任何皮质下位置。“微创”定义为使用带内镜可视化的管状牵开器。
共有15例连续患者接受了深部转移瘤的手术切除，平均年龄±标准差为63±12岁。肿瘤位于半卵圆中心7例（47%）（3例累及皮质脊髓束，2例累及上纵束，1例累及视束，1例累及额枕下束），基底神经节3例（20%），丘脑2例（13%），小脑3例（20%）。中位切除率为100%（四分位间距：100 - 100%），术后，分别有7例（47%）、7例（47%）和1例（7%）的卡氏功能状态评分改善、稳定和恶化。没有患者出现明显的局部并发症，包括中风、感染、出血和/或癫痫发作。所有患者均接受了术后立体定向放射外科治疗。
这种微创方法可用于对风险最高的转移性脑肿瘤进行广泛切除，且发病率最低。
