【摘要】 目的探讨侧方非功能区入路切除功能区脑胶质瘤的安全性。方法 2018年8月～2019年12月对36例功能区脑胶质瘤行侧方避开功能区皮层的手术入路,导航、显微镜下黄荧光指引下切除脑内胶质瘤,入路包括利用脑叶旁间隙、附近非功能区脑沟回和功能区皮层侧方进入3种方式。应用格拉斯哥预后评分(Glasgow Outcome Scale,GOS)评估术后神经功能状况。结果肿瘤全切除26例(72.2%),近全切除4例(11.1%),次全切5例(13.9%),大部切除1例(2.8%)。术后肢体肌力较术前改善10例(27.8%),言语功能较术前改善5例(13.9%)。GOS评分5分30例,4分6例。36例随访4～20个月,平均11个月。偏瘫进一步恢复3例,失语进一步恢复2例,癫痫继续发作2例,肿瘤复发8例(首次术后6～8个月复发,复发后再次手术4例)。3例分别于首次手术后11、12、18个月发生继发中线播散。1例原发性胶质母细胞瘤未能进行有效的放化疗,术后11个月死亡,且6-氧-甲基鸟嘌呤-DNA-甲基转移酶阴性,异柠檬酸脱氢酶-1(isocitrate dehydrogenase 1, IDH1)野生型。结论侧方非功能区入路切除功能区脑胶质瘤安全可行、微创,值得推广。更多还原

【Abstract】 Objective To analyze the safety of lateral nonfunctional area approaches for resection the glioma under brain functional cortex. Methods From August 2018 to December 2019, 36 patients were presented and suffered with glioma under brain functional cortex. Lateral non-functional area approaches were performed in all the 36 patients, assisted with neuronavigation and yellow flourescence. Lateral non-functional area approaches included three types: natural space beside the functional lobuscerebris,adjoined non-functional cerebral cortex, and lateral functional cerebral cortex. The Glasgow Outcome Scale(GOS) was used to judge the postoperative nervous functional state of patients. Results Gross total resection was performed in 26(72.2%) cases under microscope, nearly total resection in 4(11.1%) cases, subtotal resection in 5(13.9%) cases, and partial resection in 1(2.8%) case. The muscle strength of limbs was improved in 10(27.8%) cases, and speech function was improved in 5(13.9%) cases after operation. Five points of GOS were gotten in 30(83.3%) cases, and four points in 6(16.7%) cases. All the 36 patients were followed up for 4-20 months(mean, 11 months). Hemiparalysis was improved in 3 cases, and speech function was improved in 2 cases. Epilepsy was reserved in 2 cases. Glioma recurred in 8 cases(from 6 to 8 months after first operation), and 4 cases accepted a second open surgery. The secondary midline spread occurred in 3 cases at 11, 12 and 18 months respectively after the first operation. One patient with primary glioblastoma failed to receive effective radiotherapy and chemotherapy, and died at 11 months after operation, whose genetic testing result was O-6-methylguanine-DNA methyltransferase(MGMT) negative and isocitrate dehydrogenase 1(IDH1) wild type. Conclusion Lateral nonfunctional area approaches are safe, minimally invasive and feasible for resection the glioma under brain functional area.更多还原