| Objective(s):Observe the clinical efficacy of multimodal microsurgery for patients with recurrent glioma,and explore the treatment mode of patients with recurrent glioma.Methods:A retrospective analysis of the clinical data of 28 patients undergoing surgical treatment for recurrence of glioma in the Second Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University from 2017 to 2020,26 patients underwent craniotomy,and 2 patients underwent ventricular resection.Intraperitoneal shunt(vp shunt)and tumor biopsy,in which 8 patients combined with intraoperative ultrasound to guide the tumor boundary in real time.Three patients were combined with intraoperative ultrasound MRI fusion imaging technology to guide tumor resection,and two patients underwent intraoperative awakening and functional area tumor resection.In 2 patients,intraoperative microscopy combined with neuroendoscopy techniques were used to remove tumors.All patients were treated with intraoperative electrophysiological monitoring techniques to guide surgical resection.The Karnofsky neurological function score(KPS)was used to evaluate the clinical efficacy one month after the operation,the tumor resection was observed by imaging,the pathology was compared with the pathological changes of the recurrent tumor,and the patients were followed up for postoperative adjuvant treatment and postoperative survival.Results:Within 1 week after operation,MRI plain scan+enhanced+diffusion confirmed total tumor resection(resection rate>90%)in 21 cases,subtotal resection(resection rate>60%,<90%)in 5 cases,tumor biopsy(only a small amount was collected)Histopathological biopsy was performed in 2 cases.Twenty-two cases of complications were assessed within one week after the operation,including 15 cases of lung infection,3 cases of poor incision healing(10.7%),2 cases of limb muscle weakness,1 case of limb superficial sensation,1 case of facial paralysis,and 1 case of hearing loss.Cases,1 case of intracranial infection.Patients with intracranial infection were followed up to death 21 days after discharge,and patients with lung infection and poor wound healing recovered well after discharge.At the time of discharge,it was assessed that the symptoms of the patients improved in 24 cases compared with before,and the improvement rate was 85.7%.The KPS score was averaged(66.07±7.37)before the operation,and the KPS score was averaged(72.14±11.00)after 1 month after the operation.The difference between the postoperative KPS score and the preoperative KPS score was statistically significant,P=0.0016<0.05.Postoperative pathology of 8 patients showed increased pathological grade.Since the follow-up,the survival time was calculated according to the maximum follow-up date,and 20 patients died.The average survival time of 28 patients was(7.98±6.42)months,the maximum survival time was 24 months,and the minimum survival time was 0.6 months.Adjuvant treatments(radiotherapy,chemotherapy,targeted therapy,etc.)were actively performed in 12 patients.Conclusion(s):Intraoperative ultrasound,intraoperative MRI ultrasound image fusion technology,neuroendoscopy technology,intraoperative awakened tumor resection,intraoperative electrophysiological monitoring technology and other multi-technology and multi-modal surgical treatment methods in the treatment of recurrent gliomas The treatment is a minimally invasive and effective method,which can relieve acute complications such as hydrocephalus,increased intracranial pressure,and cerebral herniation;remove tumors,improve patient symptoms,and prolong survival;clarify pathological classification for follow-up Provide basis for the formulation of adjuvant treatment plan.Combined therapy with new types of therapy,such as chemotherapy,radiotherapy,molecular targeted therapy,and immune activation therapy,may bring new hope to patients with recurrent glioma. |
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