A Theraputic Analysis And Explorative Research Of The Treatment Of Multimodal Technique On Insular-involving Gliomas

Objective:The insular-involving gliomas(IIG) distribute throughout deep anatomical locations and are always adjacent to vessels and eloquent areas. Multimodal technique (MT) improves the rate of total resection(RTR) and reduces mortality. This study aims to evaluate MT in the IIG in terms of the diagnosis and treatment.Methods:Retrospectively studied 143 cases of IIG follow-up in our center, analysed RTR and associated factors with several chi-square tests between MT and conventional groups. Systematically summarized survival outcome of LGGs and HGGs on IIG, determined factors on survival with univariate and multivariate analysis subsequently. Meanwhile, studied 43 cases whose tumor was adjacent to CST(Corticospinal tract) in MT group, research the preoperative tumor volume, tumor diameter, distance from tumor edge to CST and width of edema margin basing on DTI, made statistical diagnosis test and analysis of variance to explore relationship between spatial pattern of tumor and eloquent areas and preoperative motor dysfunction and postoperative motor status.Results:MT significantly improve the RTR of IIG(88.5%). Gender, age, location of main part of tumor, tumor side, extent of the brain lobe with tumor involving were all of no relation to the rate. Survival analysis of 71 cases showed that the median follow-up was 47 months, including 21 and 25 events of progression and death respectively. Pathological grading, EOR(Extent of resection), adoption of MT were predictive factors of OS on IIG. Among LGGs(Low grade gliomas), median time of PFS and OS were not obtained, mean OS time was 59 months, and EOR is the unique factors of PFS. Median OS time was 22 months among HGGs(High grade gliomas), pathological grading and extent of the brain lobe with tumor involving were independent factors.Moreover, tumor diameter and width of edema margin were found to be related to preoperative motor dysfunction while tumor volume and distance from tumor to CST were need to be further investigated. Patients whose preoperative tumor diameter was greater than 69.5mm were more likely to suffer from motor dysfunction. Cases with wider edema margin were found in expectation of improvement of postoperative motor function.Conclusion:1. MT is quite effective on ⅡG which increases the RTR and improve survival outcome. This technique is feasible and worthy of clinical application and promotion.2. Under the DTI of MT, such as CST on ⅡG, it is routinely available to fulfill the tractgoraphy of eloquent areas, obtain spatial parameters, display location pattern of tumor and eloquent areas, plan individual surgical strategy while considering preserving neurological function.