تعیین نقش MRI فانکشنال مغزی قبل از عمل جراحی ضایعات اینترا اگزیال ناحیه سوپراتنتوریال بر تصمیم جراح در تعیین رویکرد و میزان تخلیه تومور و فرجام 6 ماهه بیماران عمل شده با استفاده از این روش در فاصله زمانی از خرداد 93 تا خرداد 95 در بیمارستان سینا


۱۰ مهر ۱۳۹۶

رزکسیون کامل ضایعات سوپراتنتوریال اینتراگزیال و کاهش عوارض ناشی از جراحی و افزایش کیفیت زندگی از اهداف جراحی رزکسیون تومور می باشد. در این مطالعه به بررسی نقش MRI فانکشنال مغزی قبل از عمل جراحی ضایعات اینترا اگزیال ناحیه سوپرا تنتوریال بر تصمیم جراح در تعیین رویکرد و میزان تخلیه تومور و فرجام بیماران تحت جراحی با استفاده از این روش می پردازیم.

مواد و روش ها: بیماران دارای تومور سوپراتنتوریال اینتراگزیال (N=41) مراجعه کننده به بیمارستان سینا در این مطالعه کوهورت آینده نگر مورد بررسی قرار گرفتند. نتایج حاصل از FMRI و روش تعیین شده برای جراحی و همچنین میزان رزکسیون تومور و معاینات عصبی پس از آن ثبت شد.

یافته ها:

7/70 % بیماران مطالعه مرد بودند. میانگین سنی بیماران مونث بالاتربود( 67/10±49 در مقابل 51/15±51/47 ).  بیماران با KPS ، 90 ( 5/41 % ) و تومورهای ناحیه Frontal (7/31 %) بیشترین درصد فراوانی را دارند. در 24 بیمار (5/58%) تومور با نواحی Eloquent در ارتباط بود. در 16 بیمار (39%) تومور Low-grade ودر 25 بیمار (61%) High-grade بودند . FMRI تنها در 2 % از بیماران سبب تغییر اپروچ شده. قرار گیری تومور در ناحیه Eloquent رابطه ای با تغییر در روش جراحی نداشت P=0.335)) ولی با تغییر در میزان تخلیه تومور رابطه معنی دار در سطح 99% داشت. رابطه معنا دار بین Tumor histology و تغییر Approach  وجود ندارد (p=0.390). در گروه عدم تغییر رزکشن ، وضعیت Language  بین قبل از جراحی و فرجام 6 ماهه (p=0.046) دارای تفاوت معنی دار است ولی در فرجام 72 ساعته (p=0.317) و 1 ماهه (p=0.180) تفاوت معنی دار نمی باشد. تفاوت وضعیت Motor در دو گروه تغییرو عدم تغییر رزکشن بعد از جراحی نسبت به قبل از جراحی به لحاظ آماری معنی دار نیست. شاخص KPS در 72 ساعت پس از جراحی بدتر شده ئ از نظر  آماری تفاوت معنا دار است (p=0.026). در 1 ماه (p=0.776)  و 6 ماه (p=0.441) بعد از جراحی بهبود نسبی مشاهده می شود. در گروه No Change، افت KPS در فرجام 72 ساعته (p=0.000) و 1 ماه (p=0.013) بعد از جراحی به لحاظ آماری معنادار است.

نتیجه گیری: 

:    بطور کلی بین انجام FMRI و تغییر Approach و میزان Resection رابطه ای وجود ندارد و همچنین تغییر در Approach و میزان Resection بعد از انجام FMRI با فرجام کلی بیماران نیز رابطه ای ندارد ، ولی در مورد تومورهایی که در نواحی Eloquent قرار دارند ، بین تغییر در میزان تخلیه تومور بعد از انجام FMRI و بهبود و یا تثبیت وضعیت بیماران در سه شاخص Language ، Motor و KPS بعد از جراحی رابطه معنی دار وجود دارد.بنابراین  می توان اینگونه نتیجه گرفت که انجام FMRI برای این نوع تومورها مفید بوده است  .

 

 

كليد واژه ها :

فانکشنال MRI ، ضایعات اینتراگزیال سوپرانتتوریال، Eloquent، فرجام عصبی.

مشخصات دانشجو:

نام: محمد علی سورکی آزاد  رشته تحصيلي: دکترای تخصصی جراحی مغز و اعصاب مقطع: سال پنچم                      گروه آموزشي    drazad223@gmail.com  پست الكترونيك دانشجو:  

اساتيد راهنما و داور:

استاد راهنما دکتر سید ابراهیم کتابچی    اساتيد مشاور دکتر عباس امیر جمشیدی و دکتر کوروش کریمی   اساتيد داور

زمان دفاع :

   روز پنجشنبه   تاريخ  11/3/96  ساعت8

مكان دفاع به آدرس:

تهران-خیابان کارگر شمالی-سه راه جلال آل احمد-مرکز آموزشی پژوهشی و درمانی بیمارستان شریعتی.

 

اطلاعات به زبان انگليسي

Title:

Determining the role of pre-operative functional brain MRI on surgeons' approaches and their decisions regarding the extent of tumour resections , in  patients with supra-tentorial and intra-axial tumours, and the 6-month outcomes of these patients

 

Abstract:

Most important goals of surgical resections of brain tumours are complete resection of supra-tentorial and intra-axial lesions , which subsequently result  in improving patients’ quality of life. In this study, we are intending to clarify the indications and also usefulness of pre-operative functional MRI , as well as its effects on surgeons’ approaches and decisions about extent of tumour resection , and finally patients’ outcomes. 

 

Methods and materials; 

In this prospective cohort study, we have investigated  all admitted patients with diagnoses of supra-tentorial and intra-axial tumours (N = 41) in Sina Hospital of Tehran. We have recorded all relevant data relating to their FMRI results, selected surgical approaches, the extent of tumour resection,  as well as their post-operative neurological examinations. 

 

Findings; 

70.7%of patients were male. Average age of female patients was higher  (49± 10.67vs 47.51 ± 15.51). Patients with KPS90 (41.5%) and who had frontal region tumours  (31.7%),  were the majority of cases . In 24 patients (58.5%),  tumours were in  the Eloquent area. Regarding tumour classification, we had low-grade tumours in 16 patients  (39%), compare to 25 patients (61%) with high-grade lesions. The surgical approaches of only 2% of patients has been altered after using pre-operative FMRI. Location of a tumour in Eloquent area has not changed the surgical methods (p=0.335) ,however this has had an obvious impact on the extent of tumour resection  (level 99%). There is no sensible relationship between tumour histology and changing the surgical approaches  (p=0.390). In that group of patients with no change in surgical resection plan (after pre-operative assessment  by FMRI ), although there was a meaningful improvement in language status 6 months after their operations compared to pre-operative stage (p = 0.046 ) , this was not the case for 72 hours  (p = 0.317) and one month  (p = 0.180). However there was no difference of outcomes regarding Motor status between these two groups. According to the collected data, the KPS has been worsened 72 hours post-operatively (p = 0.026), but it has shown partial improvements after one month  (p = 0.776) and also 6 months  (p = 0.441). At the same time in the no-change group, there has been a post-operative decline in the KPS in both 72 hours  (p = 0.000) and one month  (p = 0.013) . 

Conclusion; 

In general ,changing surgical approaches due to results of  pre-operative FMRIs , has not had  meaningful relations with the extent  of tumour resections. Moreover  changes of surgical approaches and/or the degree of tumour resections as a result of pre-operative FMRI findings , do not affect the final outcomes of patients. However for those patients with Eloquent region tumours, all the three abovementioned criteria, (Motor, KPS, Language ) , have shown improvements after changes of approaches due to FMRI findings. Hence we can conclude that performing pre-operative FMRI can be beneficial for those patients who are suffering from Eloquent region tumours. 

 

 

Keywords:

Functional MRI , Intra-axial Supra-tentorial Lesions, Eloquent, Neurological Outcomes

 

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منبع: معاونت پژوهشي دانشکده پزشکي