As one of the more common malignant tumors in the skull, the incidence of glioma has been increasing year by year in recent years. Gliomas can appear anywhere in the central nervous system and will jeopardize the quality of patient’s survival if improperly treated, or if treatment is not timely.
Surgical resection is the treatment of choice for glioma, and the death and disability rates of traditional surgical approaches are relatively high. In recent years, with the continuous improvement of the level of microsurgical techniques, it has been gradually applied in the resection of brain tumors, and has achieved better clinical efficacy. In this study, all 40 patients with glioma treated in our hospital between March 2009 and March 2012 were treated with microsurgery and achieved good clinical efficacy. The results are reported as follows for clinical reference.
1.Data and methods
(1) General information
From March 2009 to March 2012, 40 patients with glioma, including 24 males and 16 females, aged 13.5~66.5 years, were treated in our hospital. Based on the patients’ clinical symptoms and signs, and combined with the corresponding auxiliary examination results, all patients were diagnosed with glioma in accordance with the relevant WHO diagnostic criteria. Among them, there were 25 supratentorial tumors and 15 infratentorial tumors; there were 10 cases with tumor diameter <5 cm and 30 cases with tumor diameter >5 cm; there were 29 cases with pathological grading of grade 1-2 and 11 cases with grading of grade 3-4.
(2) Surgical method
Half an hour before surgery, 10 mg of dexamethasone and 250 ml of 20% mannitol were rapidly administered intravenously. Relying on MRI imaging, the tumor was accurately localized. At the same time, the size and position of the flap were designed with the aim of achieving maximum field exposure with the smallest incision. Surgical approaches such as coronal approach, trans-pterygoid point or expanded pterygoid point approach, posterior median or paramedian approach were routinely used to avoid important functional areas in the skull as much as possible. After the surface arachnoid was released, the tumor was visible through the microscope, which was located in the white matter of the brain and showed a purplish or fish-like color. Strictly follow the order of entering by the peripheral edema zone of the tumor, or the gliosis zone, and pay attention to the protection of brain tissue when separating, so that the tumor tissue is completely clear.
(3) Evaluation criteria for the degree of glioma resection
①Grade Ⅰ: all tumor lesions are excised and pathological results show no tumor cells.
②Grade II: All tumor lesions were excised, limited to microsurgical resection, but no pathological confirmation, and all tumors were removed.
③ Grade III: The tumor lesions were basically completely resected, with suspected or little tumor tissue remaining, but not more than 5% of the total tumor tissue.
Grade ④: Most of the tumor lesions were resected, and the resected tumor was more than 80%.
Grade V: partial resection of tumor lesions.
(4) Judgment standard of clinical efficacy
(1) Apparent effect: the tumor lesion disappears;
②Effective: tumor lesion shrinks ≥50%;
(3) Invalid: tumor lesion shrinkage is between 25% and 50%. Total effective = effective + effective.
2.Results
(1) The resection degree of glioma treated by microsurgery Among 40 patients with glioma, after microsurgical resection of tumor, there were 13 cases with resection degree of grade I, 17 cases with resection degree of grade II, 6 cases with resection degree of grade III, 4 cases with resection degree of grade IV, and 0 cases with resection degree of grade V.
(2) Clinical efficacy of microsurgery for glioma Among 40 patients with glioma, 15 cases were effective, 24 cases were effective, and 1 case was ineffective after fiber surgical resection, and the total effective rate of treatment was 97.5%.
3. Discussion
Preoperatively, the surgical incision of microsurgery is designed according to the imaging results, so that the tumor tissue can be fully exposed, and the unnecessary exposure of brain tissue can be reduced to better protect the neurological function. During microsurgery, the lesion tissue can be fully exposed by automatic retractor, thus reducing the traction damage to brain tissue; moreover, the tumor tissue, tumor glial proliferation zone, peritumor and other tissues can be more clearly identified, which not only can achieve the microscopic state for total tumor resection, but also can protect the important area of brain tissue, ensure the blood supply of important area of brain tissue, and maximize the It can also protect the important brain tissues, ensure the blood supply to the important brain tissues and preserve the brain nerve function.
Normal brain tissues are white, slightly tough and smooth, with relatively small internal blood vessels, while tumor tissues are grayish-red or yellowish-brown, with relatively brittle texture, rotten flesh-like, infiltrative growth, and relatively more internal blood vessels. Because of the existence of edema zone between tumor tissue and normal brain tissue, the tumor tissue can be removed relatively easily under the surgical microscope according to the regional demarcation, which largely increases the total resection rate of glioma. If the tumor tissue is relatively superficial and small, the surrounding arachnoid membrane, as well as the blood supply vessels, will be electrocoagulated, while the normal vascular tissue will be protected and freed, and the tumor supply vessels will be cut off by electrocoagulation until the whole tumor lesion is removed. If the tumor is relatively large, the intra-tumor tissues are first removed and then total resection is performed. For tumor lesions in important functional areas, total or subtotal resection of the tumor can be performed under microscope by entrance from non-functional areas, thus entering the tumor lesions in functional areas. Microsurgery for the treatment of glioma can remove the tumor more thoroughly and with relatively less trauma, and the indications for surgery are appropriately expanded, which overcomes some defects of traditional surgical treatment methods and significantly improves the quality of life of patients.