| Objective:To investigate the feasibility and the clinical application value of high field intraoperative magnetic imaging combined with functional neuronavigation technique in the surgery.of low grade neuroepithelial tumorsin lateral ventricles.Methods:Low grade neuroepithelial tumors(NETs) in lateral ventricles treated between February2009and December2010were perspectively investigatedas the currently treated group. According topreoperative discussion, relatively large or difficult tumors of this group were operated on with both iMRI and functional neuronavigation(iMRI group); the others were treatedwithfunctional neuronavigationonly(current control group). Low grade NETs in lateral ventricles treated between January2005and February2009were retrospectively reviewed as thehistorical control group. There were totally72cases involved with24cases in the iMRI group,18cases in the current control group,and30cases in thehistorical control group. Thepreoperative,intraoperative,postoperative as well as follow-up information of the patients were then analyzed or compared between each two different groups. The preoperativeinformationincludesdemographics, clinical manifestation,KPS scale,pathologic type,tumor volume and side, surgical approach and so on. The intraoperative data involves iMRI findings, operation time and so on. The postoperative and follow-up information comprises total resection rate, incidences of postoperative coma, motor weakness, speech disturbance, visual defict, memory deficit,fever and intracranial infection, intraeranial hemorrhage and reoperation,seizure, hydrocephalus,tumor recurrence and so on.Results:①There were no statistic differences in preoperative information among the iMRI group, the current control groupand the historical control group, except fortumor volume.Tumor volume of the iMRI group (46.12±19.90cm3) was statisticallylarger than that of the current control group (21.81±12.36cm3) or historical control group (34.30±18.04cm3)(P<0.05); Tumor volume of the current control group was statistically smaller than that of the other two groups (P<0.05) While no Statistic difference of tumor volume was showed between the currently treated patients (35.70±20.83cm3) and the historical control group.②The final (91.67%) total resection rate of the iMRIgroup was statistically higher than what the first (66.67%) iMRI scan showed (P<0.05).The total resection rate of the currently treated group (92.86%) was statistically higher than that of the historical control group (70%)(P<0.05).③The iMRI group,current control group as well ascurrently treated patients all showed a lower rate than the historical control group,in terms of postoperative coma, motor weakness, speech disturbance, visual defict and tumor recurrence. Unfortunately all these differences could not reach the statistical significance (P>0.05).④Intracranial hematomas ocurred in6of all the patients (8.33%).3of the6cases were in the historical control groupand all the3patients were reoperated on for hematomas. The other3cases were belong to the iMRI group and all of them were detected by iMRI scan intraoperatively. One of hematomas in the iMRI groupwas not evacuated immediately for its mall volume, but postoperatively the hematoma progressed and a reoperation was required.⑤The iMRI group (8.65±2.35h) showed a statistically longer operation time than that of the current control group (5.68±1.42h) or historical control group (6.43±1.65h)(P<0.05). As to the rates of postoperative fever or intracranial infection, there was no statistic differences among the iMRI group(62.50%,12.50%),current control group (50%,11.11%) and historical control group (60.00%,13.33%)Conclusion:It is feasible and safe using the combination techniqueofhigh field iMRIand functional neuronavigation to guide the operation of low grade NETs in lateral ventricles. This combination technique can help to achieve high total resection rate in the surgery of low grade NETs in lateral ventricles, especially for large tumors, and might be helpful for lower tumor recurrence. High field iMRI can detect unexpected intracranial hemorrhages timely and reduce the related damage. The radical operation with this combination technique will not be accompanied by higher ratesof functionaldeficits, including coma, motor weakness, speech disturbance and visual defict, converselythis combination technique mighthelp in reducing these deficits. This combination technique may not affect the incidences ofpostoperative memory deficit, seizure and hydrocephalus. This combination techniquemay prolong the operation time of low grade NETs in lateral ventricles, but does not increase the feversor intracranial infections. |
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