■尽管有最新的手术辅助工具和工具,手术切除浸润性脑肿瘤仍然是一个挑战。不清晰的边距,水肿区,和渗透行为是总清除量失败的主要原因。此外,肿瘤周围组织的过度切除通常有损害附近功能皮质和皮质下结构的风险,患者的生活质量和术后功能状态有不可接受的下降,以及使患者没有资格接受辅助治疗的风险。清醒手术和术中磁共振成像(ioMRI)是防止功能性脑损伤同时最大程度切除的最有效辅助手段之一。
我们介绍了2014年7月至2017年2月在Southmead医院(北布里斯托尔NHSTrust)使用ioMRI加减清醒手术进行手术的46例患者系列。设置,患者特征,适应症,肿瘤的类型和大小,手术次数,切除范围,发病率,和生存进行了分析和讨论。
■总的来说,ioMRI检查导致第1组切除+43%,第2组切除+58%。在2级肿瘤中,GTR在第1组中为46%,在第2组中为55%(在对照组中为41%)。在3级肿瘤中,GTR在第1组中为57%,在第2组中为66%(在对照组中为30%)。在4级肿瘤中,第1组的GTR为63%,第2组的GTR为66%(对照组为36%)。就剧院职业而言,ioMRI的使用增加了1/2的手术期;清醒手术的增加意味着使用另一个1/2的手术期.各组之间的发病率没有差异,术后永久性缺陷发生率低(<5%)。与对照组相比,第2组的OS在统计学上更长。
■使用ioMRI和清醒手术对麻醉团队要求很高,工作人员护士,为了病人。然而,低发病率,更高的总切除率,和更长的生存期表明,它的使用是有效的,使更容易接近的所有级别的胶质瘤,我们会认为“复杂”,由于其固有的特征或位置。
UNASSIGNED: Despite the most recent surgical aids and tools, surgical removal of infiltrating brain tumors remains a challenge. Unclear margins, edematous areas, and infiltrative behavior are the main causes for failing gross total removals. Also, excessive resection of peri-tumoral tissue often carries risks of damaging the nearby functioning cortical and subcortical structures with an unacceptable decrease in patient\'s quality of life and postoperative functional status, and the risk of making patients not eligible to adjuvant treatments. Awake surgery and intraoperative magnetic resonance imaging (ioMRI) are among the most effective aids in preventing damage to functional brain while maximizing the extent of resection.
UNASSIGNED: We present our series of 46 patients operated on at Southmead Hospital (North Bristol NHS Trust) in between July 2014 and February 2017 using ioMRI plus or minus awake surgery. Setting, patient features, indications, type and size of tumors, surgical times, extent of resection, morbidity, and survival are analyzed and discussed.
UNASSIGNED: Overall, ioMRI check led to a +43% resections in Group 1 and +58% in Group 2. In grade 2 tumors, GTR was 46% in Group 1 and 55% in Group 2 (41% in control group). In grade 3 tumors, GTR was 57% in Group 1 and 66% in Group 2 (30% in control group). In Grade 4 tumors, GTR was 63% in Group 1, 66% in Group 2 (36% in control group). In terms of theatre occupation, the use of ioMRI added 1/2 operative session; the addition of awake surgery implied the use of another 1/2 operative session. Morbidity did not differ among the groups, with low incidence of permanent post-operative deficits (<5%). Group 2 OS was statistically longer when compared to the control group.
UNASSIGNED: Using ioMRI together with awake surgery is demanding for the anesthetic team, staff nurses, and for the patient. Nevertheless, low morbidity, greater total resections rates, and longer survival suggest its use is effective in making more approachable gliomas of all grades that we would consider \"complex\" due to their intrinsic features or locations.