Intraoperative awake combined with neuronavigation in surgery for eloquent area gliomas
10.3760/cma.j.cn115354-20191018-00601
- VernacularTitle:术中唤醒结合神经导航在脑功能区胶质瘤手术中的应用价值分析
- Author:
Haibo SU
1
;
Lingqiong ZHANG
;
Baodong CHEN
;
Miao ZHANG
;
Ruiping SHI
;
Tao WU
Author Information
1. 北京大学深圳医院神经外科，深圳 518036
- Keywords:
Glioma;
Eloquent area;
Neuronavigation;
Intraoperative awake;
Cortex stimulation
- From:
Chinese Journal of Neuromedicine
2020;19(6):546-551
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the application value of intraoperative awake combined with neuronavigation in surgery for eloquent area gliomas.Methods:Twenty patients with eloquent area gliomas, admitted to our hospital from October 2017 to June 2019, were chosen in our study. Preoperative blood oxygenation level dependent-functional MR imaging (BOLT-fMRI) was used to display the functional cortex in all patients, and diffusion tensor imaging (DTI) was used to reconstruct the peripheral fibrous tracts of the gliomas; after imaging fusion of above function structures, the data were imported into the neuronavigation system; intraoperative microscope was used to determine the functional areas in the cortex and the fiber bundle, and intraoperative awake combined with cortical stimulus was employed to determine the functional areas in the cortex again before removal of the tumors. Changes in patients' quality of life (Karnofsky performance scale, [KPS] scores) before surgery, 2 weeks after surgery, and 3 months after surgery were compared, and surgical-related complications or death were recorded.Results:Intraoperative awake combined with neuronavigation were successfully applied with the addition of cortical electrical stimulation in all 20 patients; 16 (80%) accepted total resection and 4 (20%) accepted subtotal resection. Follow-up for 2 weeks after surgery and 3 months after surgery showed that only one patient with high-grade glioma had decreased KPS scores than those before surgery, and there were no postoperative deaths or severe disabilities. As compared with KPS scores before surgery(83.02±4.76), those at 2 weeks after surgery (90.15±6.72) and 3 months after surgery (96.86±6.18) were significantly higher ( P<0.05). Conclusion:Intraoperative awake combined with neuronavigation can locate the eloquent area and fibers accurately, help neurosurgeons to resect gliomas totally in the surgery and protect patients' neuro-function.
