摘要
目的介绍一种新的岛叶胶质瘤手术入路,并探索其是否可以最大程度安全切除岛叶胶质瘤。方法纳入解放军总医院第一医学中心神经外科的岛叶胶质瘤患者,所有胶质瘤切除均采用经额峡部入路。手术过程包括:1.建立额叶岛窗,2.确认峡部位置进入岛叶,3.解剖性切除岛叶肿瘤。统计肿瘤切除程度和功能保留率。结果共39例患者纳入研究,包括男性24例,女性15例,平均年龄40.7岁。根据Berger-Sanai分类系统,所有肿瘤至少涉及Ⅰ区,最常见的是巨大型胶质瘤(65.3%),其次是Ⅰ+Ⅳ区(21.7%)。根据Yasargil的分类,Yasargil 3B型15例,5A/B型24例。壳核受累9例,壳核未受累30例。术前肿瘤体积中位数和四分位间距(IQR)为56.4(43.7,81.3)mL,28例LGG中,17例(60.7%)肿瘤获得了全切除;在11例HGG中,10例(90.9%)肿瘤获得了全切除术。3个月后,所有患者的肌力都达4级以上。术后3个月随访时所有患者都表现出基本正常的言语功能。术后3个月时KPS中位值为90(IQR 80~90)。结论经额峡部入路对BergerSanaiⅡ区的岛叶肿瘤的切除具有优势,可以达到岛叶胶质瘤的最大程度安全切除。
Objective To introduce a new approach for insular glioma surgery and explore the possibility of the safe removal of insular glioma to the greatest extent.Methods Patients with insular glioma admitted to the First Medical Center of the PLA General Hospital were enrolled,all of whom underwent surgery through the frontal isthmus approach.The extent of tumor resection and functional preservation rate were analyzed.Results A total of 39 patients were included in the study,including 24 men and 15women,with an average age of 40.7 years old.According to the Berger-Sanai classification system,all enrolled patients were involved in at least ZoneⅠ,with giant glioma being the most common(65.3%),followed byⅠ+Ⅳ(21.7%).According to the classification of yasargil,there were 15 cases of type 3B and 24 cases of type 5A/B.There were 9 cases with putamen involvement,and 30 cases without putamen involvement.The median tumor volume and interquartile range(IQR)were 56.4(43.7,81.3)mL before surgery,and 17(60.7%)of the 28 LGGs achieved complete resection.Of the 11 HGGs,10 patients(90.9%)got total resection.All patients had muscle strength above grade 4,and exhibited nearly normal speech at the 3-month follow-up examination.The median postoperative KPS at 3 months postoperatively was 90(IQR 80–90).Conclusions The frontal isthmus approach changes the working angle,which has an advantage over the resection of the ZoneⅡ,and can achieve the maximum safe resection of insular glioma.
作者
孙国臣
吴东东
赵恺
程岗
束旭俊
丛小钧
周星宇
李彦腾
张剑宁
SUN Guochen;WU Dongdong;ZHAO Kai;CHENG Gang;SHU Xujun;CONG Xiaojun;ZHOU Xingyu;LI Yanteng;ZHANG Jianning(Departments of Neurosurgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Neurosurgery,Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing,Jiangsu 210016,China)
出处
《中华神经外科疾病研究杂志》
2025年第3期38-43,共6页
Chinese Journal of Neurosurgical Disease Research
关键词
岛叶
胶质瘤
峡部
手术
Insular lobe
Glioma
Isthmus
Surgery
