局限性脑干胶质瘤的显微神经外科治疗

摘要

目的：探讨在神经电生理监测、术中导航及功能磁共振辅助下，局限性脑干胶质瘤的显微外科治疗及疗效。方法回顾性分析18例局限性脑干胶质瘤患者的临床资料。所有患者病变均位于脑干，在术前功能磁共振、术中导航及神经电生理监测的辅助下行显微外科治疗。结果胶质瘤Ⅰ～Ⅱ级7例，Ⅲ～Ⅳ级11例。肿瘤位于脑桥14例，位于延髓3例，位于中脑1例。肿瘤近全切除12例，部分切除6例。术后9例患者较术前神经功能障碍好转，6例患者较术前无明显好转，3例患者出现新的神经功能损害。平均随访26个月，随访期内2例位于脑桥的Ⅳ级胶质瘤患者肿瘤分别于术后8个月及14个月时复发。结论神经电生理监测、术中导航及功能磁共振辅助能明显提高局限性脑干胶质瘤显微外科治疗的切除率，有助于安全并最大限度的切除脑干胶质瘤，延长患者生存期。%Objective To explore the effectiveness of the microsurgical resection of the focal brain stem gliomas ( BSG ) assisted by neurophysiological monitoring , intraoperative neuronavigation and diffusion tensor imaging fiber tracking (DTI-FT).Methods The clinical data of 18 patients with the focal brain stem gliomas who underwent microsurgery were analyzed retrospectively .All the lesions located in the brain stem .All the patients underwent microsurgery assisted by DTI , Neuro-navigation and neurophysiology monitoring .Results Of 18 cases,7 wereⅠ-Ⅱgliomas and 11 wereⅢ-Ⅳgliomas. 14 lesions located in pon ,3 located in medulla oblongata and 1 located in the midbrain .Subtotal tumor resection and partial resection was achieved in 12 and 6 patients respectively .After the operation ,9 patients recovered to a better status , 6 remained neurologically stable , and 3 developed new neurological dysfunction .The mean follow-up period was 26 months.Tumor recurrence was observed during follow-up in 2 patients whose tumor were grade Ⅳgliomas.Conclusion With intraoperative neurophysiological monitoring ,intraoperative neuronavigation and DTI-FT,total microsurgical removal can be performed with low mortality and favorable prognosis of neurological function .