脑转移瘤切除的“超边缘”理念
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深圳市第二人民医院

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The " supramarginal resection " concept of brain metastasectomy
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    摘要:

    脑转移瘤(Brain Metastases, BMs)是一些恶性肿瘤的常见并发症,约30%的肿瘤患者会出现脑转移 ,发生率是脑原发性脑瘤的10倍左右 ,多数来源于肺癌(20-56%)、乳腺癌(5-20%)和黑色素瘤(7-16%) 。手术作为神经外科治疗颅脑肿瘤最传统的方式依然发挥着不可替代的作用,但BM的传统全切术后往往复发率较高,越来越多的临床与病理证据支持BM与脑组织并非界线分明,致使脑转移瘤的“超边缘切除”应运而生。介于脑功能的保护,应用之初仅限于非功能区,现如今已携手电生理检测、导航系统、术中唤醒等精密手段走进功能区,并在手术入路、瘤体切除等方面不断更新理念,努力在最大范围切除肿瘤与保护脑功能之间做到最优化。通过回顾大量脑转移瘤的超边缘切除相关研究,本文系统阐述了该手术方式的发生与发展。

    Abstract:

    Brain Metastases ( BMs ) are common complications of solid tumors and even non-solid tumors. Brain metastases often occur in up to 30 percent of tumor patients. Especially with the progress of medical technology, the survival time of patients with malignant tumors is significantly prolonged, and the relative incidence of intracranial metastasis has risen to about ten times that of primary brain tumors. Any type of primary tumor can be transferred to the brain, including lung cancer ( 20 – 56 percent ), breast cancer ( 5 – 20 percent), and melanoma ( 7 – 16 percent ). Intracranial metastasis of malignant tumors often indicates a poor prognosis. It dramatically shortens the overall survival of patients and often leads to a significant decline in quality of life due to focal neurological dysfunction and cognitive impairment. The treatment of contemporary brain metastases is changing with each passing day, and a multi-choice precise treatment system has been formed, including surgery, whole-brain radiotherapy, stereotactic radiotherapy, targeted therapy, and palliative treatment. As the most traditional way of neurosurgery in the treatment of brain tumors, surgery still plays an irreplaceable role, with unique advantages such as reducing brain tissue compliance, rapidly improving neurological dysfunction, and clarifying the pathological diagnosis. However, the traditional total resection of Brain Metastases is often insufficient to achieve local tumor control, and the recurrence rate is often high after the conventional complete resection of Brain Metastases. More and more clinical and pathological evidence support that Brain Metastases and brain tissue are not clearly defined. The vast majority of BM histologically showed an irregular tumor-brain interface. These tumor cells infiltrated into the surrounding normal brain tissue are not enhanced on enhanced magnetic resonance imaging, so they are often ignored. In line with the principle of expanding resection and reducing recurrence of brain metastases, ' super-marginal resection ' of brain metastases came into being. According to existing studies, super-marginal resection of brain metastases can significantly improve tumor recurrence rate. In the protection of brain function, the application of super-marginal resection was limited to non-functional brain Metastases at the beginning. Now, functional brain Metastases can be resected by combining intraoperative electrophysiological detection, neuronavigation system, intraoperative awakening, and other precise means. In recent years, the concept of super-marginal resection of Brain Metastases has been updated and innovated in terms of surgical approach, tumor resection, and neuroendoscopy, and efforts have been made to optimize the maximum resection of tumors and the protection of brain function. By reviewing a large number of studies on supramarginal resection of brain metastases, this paper systematically expounds on the basis of this surgical method and constantly combines new technologies, new approaches, and new ideas to mature the development process.

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  • 收稿日期:2022-04-12
  • 最后修改日期:2022-06-12
  • 录用日期:2022-07-25
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