Moiraghi Alessandro, Prada Francesco, Delaidelli Alberto, Guatta Ramona, May Adrien, Bartoli Andrea, Saini Marco, Perin Alessandro, Wälchli Thomas, Momjian Shahan, Bijlenga Philippe, Schaller Karl, DiMeco Francesco
Division of Neurosurgery, University of Geneva Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta," Milan, Italy.
Oper Neurosurg (Hagerstown). 2020 Apr 1;18(4):363-373. doi: 10.1093/ons/opz203.
Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter.
To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN.
We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated.
The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01).
The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.
在保留神经功能的同时最大化切除范围（EOR）并减少残余肿瘤体积（RTV）是胶质瘤手术治疗的主要目标。术中导航超声（N-ioUS）结合了超声和传统神经导航（NN）的优势，能够克服后者的局限性。
与标准神经导航相比，评估实时神经导航结合术中超声和术前磁共振成像（MRI）对胶质瘤手术中最大化EOR的影响。
我们回顾性分析了一系列60例幕上胶质瘤手术病例：31例在术中导航超声引导下进行手术，29例采用标准神经导航切除。评估了年龄、肿瘤位置、术前和术后卡氏功能状态（KPS）、EOR、RTV以及术后并发症（如有）。
神经导航组的全切除率（GTR）为44.8%，而术中导航超声组为61.2%。术中导航超声组胶质母细胞瘤的RTV>1 cm³发生率显著更低（P<.01）。在31例中的13例（42%）中，术中导航超声在手术结束时检测到了RTV。在13例中的8例（占队列的25.8%）中，外科医生继续手术直至完全切除。术中导航超声的特异性更高（42%对31%），阴性预测值也更高（73%对54%）。出院时，术中导航超声组术前和术后KPS的差异显著更大（P<.01）。
与标准神经导航相比，基于术中导航超声的实时导航在非功能区高级别胶质瘤的切除中，在EOR和神经功能结果方面均有益处。术中导航超声已被证明在检测RTV>1 cm³方面有用。
