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首页> 外文期刊>Neurosurgery >Image-guided craniotomy for cerebral metastases: techniques and outcomes.
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Image-guided craniotomy for cerebral metastases: techniques and outcomes.

机译：影像引导的颅骨转移颅骨开颅术：技术和结果。

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OBJECTIVE: The purpose of the present study was to analyze the outcomes after craniotomies for brain metastases in a modern series using image-guided technologies either in the regular operating room or in the intraoperative magnetic resonance imaging unit. METHODS: Neurosurgical outcomes were analyzed for 49 patients who underwent 55 image-guided craniotomies for excision of brain metastases during a 5-year period. Tumors were located in critical and noncritical function regions of the brain. A total of 23 craniotomies for tumors in critical brain were performed using intravenous sedation anesthesia; craniotomies for noncritical function brain regions were completed under general anesthesia. The patients were also divided into Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classes on the basis of age, Karnofsky Performance Scale scores, state of primary disease, and presence or absence of extracranial metastases. RESULTS: There was no perioperative mortality. Gross total resection, as verified by postoperative contrast-enhanced computed tomography or magnetic resonance imaging, was achieved in 96% of patients. The median anesthesia time was 4.25 hours, and the median length of hospital stay was 3 days. In 51 symptomatic cases, there was complete resolution of symptoms in 70% (n = 36), improvement in 14% (n = 7), and no change in 12% (n = 6) postoperatively. No patient who was neurologically intact preoperatively deteriorated after surgery, and 93% of patients maintained or improved their functional status. Only two patients (3.6%) with significant preoperative deficits had increased long-term deficits postoperatively. The mean follow-up was 1 year, and the local recurrence rate was 16%. The median survival of the entire group was 16.23 months (17.5 mo in RPA Class I, 22.9 mo in RPA Class II, and 9.8 mo in RPA Class III). CONCLUSION: Gross total resection of brain metastases, including those involving critical function areas, can be safely achieved with a low morbidity rate using contemporary image-guided systems. RPA Class I and II patients with controlled primary disease benefit from aggressive treatment by surgery and radiation.
机译：目的：本研究的目的是在常规手术室或术中磁共振成像单元中使用图像引导技术，对现代系列颅脑转移术后开颅手术后的结果进行分析。方法：分析了在5年期间行55例图像引导开颅手术切除脑转移的49例患者的神经外科手术结果。肿瘤位于大脑的关键和非关键功能区域。静脉镇静麻醉共进行了23例关键脑肿瘤的开颅手术;非关键功能脑区域的开颅手术在全身麻醉下完成。根据年龄，卡诺夫斯基绩效量表评分，原发疾病状态以及是否存在颅外转移，将患者分为放射治疗肿瘤学小组递归分区分析（RPA）类。结果：没有围手术期死亡。经术后对比增强计算机断层扫描或磁共振成像证实的总全切除术在96％的患者中得以实现。中位麻醉时间为4.25小时，住院时间中位数为3天。在51例有症状的病例中，术后症状完全缓解的占70％（n = 36），改善了14％（n = 7），而术后12％（n = 6）没有变化。术前无神经完整的患者术后无恶化，并且93％的患者保持或改善了其功能状态。仅有2例（3.6％）术前有明显缺陷的患者术后长期缺陷增加。平均随访1年，局部复发率为16％。整个组的中位生存期为16.23个月（RPA I类为17.5个月，RPA II类为22.9个月，RPA III类为9.8个月）。结论：使用现代图像引导系统可以低发病率安全地实现包括肿瘤转移在内的全脑切除。患有受控原发性疾病的RPA I类和II类患者可通过外科手术和放射治疗积极治疗。

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