Azad Tej D, Duffau Hugues
1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and.
2Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France.
Neurosurg Focus. 2020 Feb 1;48(2):E12. doi: 10.3171/2019.11.FOCUS19769.
The optimal surgical management of gliomas requires a balance between surgical cytoreduction and preservation of neurological function. Preoperative functional neuroimaging, such as functional MRI (fMRI) and diffusion tensor imaging (DTI), has emerged as a possible tool to inform patient selection and surgical planning. However, evidence that preoperative fMRI or DTI improves extent of resection, limits neurological morbidity, and broadens surgical indications in classically eloquent areas is lacking. In this review, the authors describe facets of functional neuroimaging techniques that may limit their impact on neurosurgical oncology and critically evaluate the evidence supporting fMRI and DTI for patient selection and operative planning in glioma surgery. The authors also propose alternative applications for functional neuroimaging in the care of glioma patients.
胶质瘤的最佳手术治疗需要在手术肿瘤细胞减灭与神经功能保留之间取得平衡。术前功能神经影像学检查，如功能磁共振成像（fMRI）和弥散张量成像（DTI），已成为指导患者选择和手术规划的一种可能工具。然而，缺乏证据表明术前fMRI或DTI能提高切除范围、限制神经功能障碍发生率以及扩大经典语言区的手术适应症。在本综述中，作者描述了功能神经影像学技术可能限制其对神经外科肿瘤学影响的方面，并严格评估支持fMRI和DTI用于胶质瘤手术患者选择和手术规划的证据。作者还提出了功能神经影像学在胶质瘤患者护理中的其他应用。
