Transcortical removal of island leaf glioma

The transcortical inlet or the external split into the road is the main way to remove the island leaf gliomaProfessor Wu Jinsong,of Neurosurgery at Huashan Hospital in Shanghai, and professor Wu Jinsong,, were able to remove gliomas from The Berger-Sinai Island leaf area by cortical tract and analyze clinical outcomes and prognosis-related factorsThe results of the study were conducted by NUFarrukh Hameed and others published in the September 2019 issue of Journal of The Economiststudy methods
a total of 255 patients with glioma from neurosurgery from March 2011 to March 2017 were patients with transcortical excisionThe tumor is partitioned according to the preoperative MRI imageBerger-Sinai Island Leaf Zoning Method: Area I and IV are the pre-island leaf area, Area I and II are the upper island leaf area, area II is the island leaf area, and area III is the lower island leaf areaThe tumor site is limited to each area for the limited type, the tumor invades all the island leaf areas for the huge typeThe histopathological types of tumors are classified as low-grade gliomas, including WHO CLASS II and WHO III IDH-1 mutant types, and high-level gliomas, including WHO III IDH-1 wild and WHO IVMost patients with tumors in the dominant hemisphere used wake-up anesthesia; cortical electrostimulation techniques were used to locate the cortical functional area during surgery; and the tumor was removed from the island leaf by cutting through a functional cortical cut to the island leafAccording to the MRI imaging results within 72 hours after surgery to determine the degree of excision (EOR), tumor total cut refers to the low-level glioma excision degree of 90%, high-level glioma excision degree of 100%; Follow-up review time for patients with low-level island leaf glioma after surgery was 3 days, 1 month, 3 months, 6 months, and after 6 months, and in patients with high-level island leaf glioma, the postoperative follow-up review time was 3 days, 1 month, and after every 3 monthsPostoperative neurofunctional defects lasted longer than 6 months for permanent neurological dysfunction and less than 6 months for temporary neurological dysfunctionthe following combined map to describe the surgical procedure (Figure 1): Figure 1 A The skull is opened; the bone window range is determined according to the tumor site and size B Open the epidural, use electrode sensing to induce potential, position the central groove C Through cortical electrical stimulation of the positioning language and motion cortex, the number1, 2, 5 statement interruption, 3 pronunciation difficult, M mouth movement area, 6, 7, 8, 9 naming barrier; Under the neural navigation positioning, the tumor boundary is profiled with a 4-0 silk coil (dotted line) D Avoid the functional area along the trench vertically cut the cortex, protect the blood vessels in the trench E Use CUSA for intra-tumor decompression F During the excision process, intermittent cortical subelectric stimulation is made to ensure that the abdominal speech pathway marked with "L" is not damaged 1 typical patient with island-leaf glioma with MRI images before, after surgery, and follow-up for 6 months (Figure 2) Figure 2 A.1 typical island-leaf glioma patients with MRI imaging before surgery, surgery, and follow-up for 6 months AF - Bow beam; ILF s lower vertical beam B.MRI images show cortical incisions that reach the island leaf tumor study included 255 patients aged 20-78, 161 men and 94 women Of these, 246 were first surgery, 9 were re-surgery after the recurrence of the tumor, 145 were on the left side, the most common symptoms were seizures (41.18%), and 76.92% of the patients received assisted treatment after surgery, of which 5.26% were pure radiotherapy, 4.21% were pure chemotherapy, and the remaining 90.53% were chemotherapy results postoperative pathology results showed that 120 cases (47.06%) of WHO II, 54 cases (21.18%) WHO III, and 81 cases (31.76%) WHO IV By comparing the 2016 WHO Central Nervous System Tumor Classification with the 2007 edition, the most common lyser melanoma (IDH1 wild type, 68/255, 26.67%), followed by diffuse astrocyma (IDH1 mutant type, 56/255, 21.96%), interdesticosis (IDH1 mutant, 36/255, 14.12%) Statistical analysis showed that the IDH1 wild type often violated one island leaf area as a restricted type, while the IDH1 mutation invaded multiple island leaf areas as a large tumor (OR?2.504; 95% CI, 1.488-4.213; P 0.001) According to the island leaf zoning, the most common island leaf glioma severs all the island leaf areas, the large type, followed by the island leaf pre-region tumor (Area I and IV) Of the 161 cases of low-grade gliomas, 107 (66.46%) were large tumors, 28 (17.39%) were ex-island pre-ethal tumors, and in 94 cases of high-level gliomas, 43 (45.74%) were large tumors and 24 (25.53%) were pre-island tumors There was no significant difference in the location of the left and right hemispheric island leaf glioma, as was the distribution of the island leaf glioma of various pathological types 172 cases (67.45%) had a tumor removal degree of 90%, of which 93 cases (57.76%) were low-level gliomas and 40 cases (42.55%) were fully cut for high-level gliomas The EOR for tumors in the high-level glioma group was 81.51%-100%, with a median of 98.85% (95% CI, 97.95% -100% ;P0.001), significantly higher than Tumor EOR 95.25%-100% in low-grade glioma group, median 95.22% (95% CI, 91.71%-97.50% ;P0.001) The highest degree of tumor removal in the pre-island area (EOR 94.00%-100%, median 98.99% ;P ;P Tumor residues are mostly located in the shell core area, the island back point area and the ring island trench area obtained data on the lifetime of 247 patients during follow-up As of the final follow-up period, 72 patients (29.15%) died, including 50 cases (69.44%) of high-level gliomas The survival of low-level gliomas was significantly longer than in patients with high-level gliomas, with 62.68 months compared to 17.00 months (P 0.001) The level of tumor removal of low levels and high levels of glioma was significantly related to survival In low-grade gliomas, the survival of patients with limited tumors was significantly higher than that of large tumors, with 73.27 months compared to 60 months (P-0.003), and in high-level gliomas, tumor partitions were not significantly correlated with survival 12.79 percent of patients with transient neurological dysfunction after surgery and 15.70 percent of patients with permanent neurological dysfunction The majority (16/19, 84.21%) after surgery had a large or post-island leaf area tumor and was located in the dominant hemisphere; Neurofunctional defects are more likely to occur after surgery of large tumors (P-0.038) conclusion
in summary, the transcortical excision of the island leaf glioma, can achieve the maximum removal of tumors in the island leaf area The precision positioning of the functional area by combining cortical intake combined with multi-modal brain imaging, intraoperative wake-up and cortical electrical stimulation techniques can significantly reduce the incidence of postoperative neurological dysfunction and prolong the survival of patients.