Diffusion Tensor Imaging With Fluorescein Sodium Staining For Dissection Of The High-grade Gliomas In Functional Brain Areas

ObjectiveTo investigate the clinical value of magnetic resonance diffusion tensor imaging(DTI)with fluorescein sodium staining(FLS)in the dissection of high-grade glioma(HGG)in functional brain areas.MethodsFrom October 2014 to October 2017,95 HGG patients with lesions located in functional brain areas,admitted to Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,were analysed retrospectively.A total of 49 cases were performed using DTI combined with FLS(observation group),and 46 cases were excised with traditional surgery(control group).In the observation group,the patients underwent enhanced MRI and DTI preoperatively to confirm the position relationship between tumor and functional fiber bundles and design surgical approach;FLS was applied to guide the removal of tumor during the operation,and the yellow fluorescence edge tissues were taken for pathological examination.In the control group,the patients received enhanced MRI preoperatively,and the tumor was removed by traditional surgery.All patients were subjected to enhanced MRI to assess the extent of tumor dissection within 72 hours after operation.The changes of muscle strength and Karnofsky performance scale(KPS)scores were evaluated in one month after surgery.ResultsThere was a remarkably higher extent of total resection in the observation group than in the control group(83.7% vs.45.7%,P<0.001).The rate of muscle strength reduction after surgery was significantly lower in the observation group than in the control group(20.4% vs.47.8%,P=0.005).KPS scores in the observation group were notably higher than in the control group(73.5% vs.47.8%,P=0.029).In the observation group,the sensitivity of FLS in identifying tumor tissue was 91.7%(44/48),with the specificity of 90.0%(45/50).ConclusionThe application of DTI combining with FLS may facilitate the maximal resection of HGG in functional brain areas with minimal loss of fiber bundles,reduce the disability rate and improve the quality of postoperative life,which is of great clinical significance.