A Cinical Study Of Neurophysiologic Monitoring In Guiding Surgery Of Gliomas Locating In The Central Cortex And Interstitial Radiotherapy Combined With Chemotherapy

Objective To evaluate the value of interstitial radiotherapy combined with chemotherapy surgical treatment by using cortical sensory evoked potentials (Co-SEP),motor evoked potentials(Co-MEP),electrocorticogram (ECoG) and awake craniotomy in therapy of gliomas.Method18cases of gliomas located in or near the central cortex were screened by CT、MR、fMRI、diffusion tensor imaging (DTI)、magnetoencephalography (MEG) and PET-CT located functional area and malignancy. Gliomas in the left side were8cases (precentral gyrus was3cases, postcentral gyrus was3cases, and together was2cases); In the right side were10cases(precentral gyrus was5cases, postcentral gyrus was2cases, and together was3cases). Myodynamia impairment in8cases used DTI, and found hand motor fiber oppressed by glimas were3cases (in the left side was2cases, in the right side was1cases) and hand and lower limb motor fiber oppressed by glimas were5cases (in the left side was3cases, in the right side was2cases). Intraoperative Co-SEP and Co-MEP were used in18cases that located median groove and motor area. Awake craniotomy located language area was used in2cases. Surgery protected that functional area and resected glimas.secondary epilepsy in3cases used ECoG that identified location and extent of epileptogenic focus. Epileptogenic focus located functional area used multiple subpial transaction (MST) or bipolar coagulation technique. Epileptogenic focus located nonfunctional area used lumpectomy. That repeating stopped until spike wave decreased. After glimas resected,5-Fluorouracil (5-FU) was embedded on tumor bed. Selecting radiological dose of125I based on three dimensional treatment planning system (3D-TPS),and were about50～60Gy.it was embed on tumor bed. Postoperative, the patients were follow up3-24months, and observed prognosis.Results In18cases,1case was total resected;13cases were secondary total resected;4cases were partial resection.In3cases of secondary epilepsy, spike waves were lost in1case, and obviously decreased by MST or bipolar coagulation technique in2cases. In postoperative2weeks, myodynamia decreased in2cases, sensation decreased in3cases, and simultaneously decreased in1case. Symptom improved and constanted in12cases. Aphasia improved by durg in2cases. Postoperative3months, surrounding of tumor bed in6cases reinforced on MR. Identification by18F-FDG PET,2cases were considered glimas recurrence, and4cases were considered necrosis of glimas. Incidence rates of preoperative complication were6/18(2cases of the muscle strength declined,3case of hypoesthesia, and both of declined was1case). Postsurgery curative effect evaluated in6months,12months, and24months. Progression-free survival (PFS) average11months. Objective effective rates were13/18、9/18and6/18. Disease control rates (DCR) were15/18、13/18and10/18. Karnofsky of preoperative and postoperative6months,12months were (84.13±12.88)、(78.20±15.13)、(62.35±13.21) and (46.57±16.93),and they are statistic difference (P<0.01).Conclusion The application of Intraoperative monitor of Co-SEP, Co-MEP combined the ECoG and evoked craniotomy in surgery can effectively located functional area and epileptogenic focus. Gliomas were removed as much as possible, while protecting important brain functions, and improved patient quality of life. Interstitial radiotherapy combined with chemotherapy may extend life span patients, and decrease recurrence of gliomas.