摘要
目的:依据颞叶内侧区解剖及各种辅助技术,探讨该区胶质瘤的手术切除策略与近期疗效。方法:回顾性分析手术切除的17例颞叶内侧区胶质瘤病人的临床资料,包括临床及影像学表现、术前评估、手术入路及技术要点、近期预后等情况。术前根据病人头颅多模态MRI成像指导手术入路和切除策略,术后早期复查头颅CT和MRI,出院前、术后1个月评价病人临床恢复情况。结果:根据术前评估结果采取改良颞前下入路12例、颞中回入路4例、颞上沟入路1例。肿瘤全切除15例(88.2%),次全切除2例(11.8%)。术后新发肢体活动障碍2例(合并感觉性失语1例)、动眼神经损伤1例,术后1个月随访上述症状均有改善;其余14例病人术后表现均较术前改善,无昏迷和死亡病人。结论:颞叶内侧区位置深在、解剖复杂,对其解剖结构的深入理解、采取合理的手术策略有助于该区胶质瘤的全切及病人神经功能保护,而多模态神经影像及术中神经导航技术的辅助价值较大。
Objective:To explore the surgical resection strategy as well as short-term outcome of gliomas in medial temporal lobe according to the anatomy and various intraoperative auxiliary techniques.Methods:The clinical data including clinical and imaging manifestations,preoperative evaluation,surgical approaches,technical points and recent prognosis in 17 patients with medial temporal lobe glioma undergoing surgical resection were retrospectively analyzed.The surgical approaches and resection strategies were guided according to the patients′multimodal cranial MRI results before operation.The cranial CT and MRI were performed again in early postoperative stage.The recovery of patients was evaluated before discharge and 1 month after operation.Results:According to the preoperative evaluation,12 patients underwent the modified anterior inferior temporal approach,4 patients underwent the middle temporal gyrus approach,and 1 patient underwent the superior temporal sulcus approach.Total resection of the tumor was achieved in 15 cases(88.2%),and subtotal resection was in 2 cases(11.8%).There were 2 cases of new limb dyskinesia(1 case complicated with sensory aphasia),1 case of oculomotor nerve injury after operation,and all the above symptoms were improved after 1 month follow-up.The remaining 14 patients showed improvement in postoperative performance compared to preoperation,with no comatose or deceased patients.Conclusions:Medial temporal lobe is deep and complex in anatomy.The further understanding of its anatomy and adopting reasonable surgical strategy are helpful for the total resection of gliomas in this area and the protection of patients′neurological functions.Multimodal neuroimaging and intraoperative neuronavigation technique have significant assistant value.
作者
李庆新
吴炳山
肖瑾
陈为为
洪文明
王卫红
徐培坤
LI Qingxin;WU Bingshan;XIAO Jin;CHEN Weiwei;HONG Wenming;WANG Weihong;XU Peikun(Department of Neurosurgery,The First Affiliated Hospital of Anhui Medical University,Hefei Anhui 230022,China)
出处
《蚌埠医学院学报》
CAS
2024年第7期862-865,869,共5页
Journal of Bengbu Medical College
基金
国家自然科学基金青年基金项目(82003795)
安徽医科大学基础与临床合作研究提升计划(2021xkjT032)。
