| Objective:Gliomas are the most common primary malignant tumors in the brain.The invasive growth of gliomas makes it difficult to distinguish the boundary,and it is very difficult to cut the whole tumor.The scope of tumor resection is closely related to the prognosis of patients.Therefore,to strive for the maximum safe range of tumor resection is the preferred treatment strategy.With the development of human brain functional network map,the concept of surgery has developed from "anatomic model" to "anatomic functional model" for gliomas that are close to,involve or invade important functional areas,and the protection of intraoperative nerve function has become the primary consideration to ensure a good quality of life for patients after surgery.The balance between the degree of resection and the protection of nerve function is the key to the treatment of gliomas in brain functional area,which will be directly related to the quality of life and prognosis of patients.How to distinguish the tumor boundary during operation is the key to determine the degree of tumor resection,and the most effective way to prevent postoperative neurological dysfunction is to make clear the cortical distribution of adjacent,involved or invaded functional areas,the position relationship between subcortical conduction fiber bundle and tumor tissue,and to ensure the integrity of conduction pathway.With the development and application of multimodal magnetic resonance,neuronavigation,intraoperative ultrasound,wake-up anesthesia,neuroelectrophysiological localization and monitoring technology,fluorescence navigation and many other new auxiliary surgical techniques,many options are provided for the surgeons.The purpose of this study is to explore the application of precision surgery based on awake craniotomy in the operation of glioma in functional areas by comparing the application of various auxiliary surgical techniques and conventional surgery in the operation of glioma in functional areas,and comparing the differences in the operation effect,postoperative complications,postoperative Karnofsky functional state score(KPS score),postoperative functional recovery and prognosis Application value in treatment.Methods:From December 2017 to June 2019,the clinical data and follow-up data of 40 patients who weretreated in neurosurgery of Henan people’s Hospital and diagnosed as gliomas in brain functional area by combining imaging data and postoperative pathology were analyzed retrospectively.Among them,20 patients in the precision operation group underwent three-dimensional reconstruction by DTI combined with conventional MRI to assist in the design of preoperative operation plan;before operation,the tumor location was accurately located under the assistance of neuronavigation to guide the incision design;after the dura incision,the size and location of the tumor were located by ultrasound to select a reasonable approach and assist in the screening of tumor residues;fluorescence navigation The technique realizes the visualization guided resection of tumor boundary.During the operation,the central sulcus,motor sensory and language functional areas were located by wakeup combined with neuroelectrophysiological localization technology,and the integrity of sensory,motor and language subcutaneous pathway was monitored by neuroelectrophysiological monitoring technology,so as to guide the protection of functional area cortex and subcutaneous pathway during the operation.In the routine operation group,20 patients were divided into two groups.The operation plan was made according to the location of the tumor and the relationship between the tumor and the anatomic functional area by MRI before the operation.In the operation,under the routine white light microscope,the functional area was located by gyrus and sulcus,and the tumor boundary and resection degree were judged according to the texture and color of the tumor.MRI was reexamined within 48-72 hours after operation in both groups,and the degree of tumor resection was evaluated and recorded.Observe and record the operation time(minutes),hospital stay(days)and postoperative complications(epilepsy,intracranial infection,pulmonary infection,deep vein thrombosis,etc.)of the two groups.Before and after the operation,all patients were assessed and recorded for muscle strength and language function.After discharge,patients were followed up for 6 months by outpatient reexamination,wechat or telephone.KPS score,muscle strength and language function were evaluated again for the two groups.The changes and recovery of language and motor function were recorded by comparing the results before,after and after the operation.According to the survival status of the patients during the follow-up,the recurrence rate and mortality rate of the two groups were calculated.SPSS 22.0statistical software was used to analyze and compare the recorded data.The data of measurement data were expressed by mean ± standard deviation(χ ± s).The comparison between groups was analyzed by t-test.For counting data expressed by frequency or percentage,x2 test was used to analyze the comparisonbetween groups,with a statistically significant difference(P < 0.05).Results:The basic data of the two groups were compared,including sex,age,preoperative KPS score,tumor volume,tumor location and postoperative pathology(P > 0.05).In the precision operation group,15patients(75%)had total tumor resection,which was significantly higher than that in the conventional operation group(8 patients(40%)(P = 0.025 < 0.05);in the precision operation group,the postoperative hospital stay was 13.15 ± 3.453 days,which was significantly shorter than that in the conventional operation group(16.35 ± 4.107 days)(P = 0.011 < 0.05);in the precision operation group,the postoperative complications were 3 patients(15%),which was significantly less than that in the conventional operation group 9 cases(45%)(P = 0.034 < 0.05).Six months after discharge,one patient(5%)in the precision operation group had permanent language or motor dysfunction,less than six patients(30%)in the routine operation group(P = 0.037 < 0.05);the KPS score in the precision operation group was 75.50 ± 14.318,significantly higher than 65.00 ± 16.384 in the routine operation group(P = 0.037< 0.05);two patients in the precision operation group had postoperative recurrence,significantly lower than that in the routine operation group(P = 0.037 < 0.05)9 cases(45%)in the operation group(P = 0.013 <0.05).There was no significant difference in the preoperative mental state assessment(mssns)score of the patients in the precision operation group(56.18 ± 2.292)and the postoperative score of 55.68 ± 2.222(P = 0.939 > 0.05).Conclusion:Accurate operation based on awake craniotomy can effectively improve the degree of tumor resection,significantly reduce the recurrence rate of tumor,improve the prognosis of patients;at the same time,shorten the length of stay,reduce postoperative complications,reduce the incidence of permanent neurological dysfunction and do not affect the psychological state of patients,improve the quality of life of patients after surgery,and surgical treatment of brain functional glioma Therapy has important clinical application value. |
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