Microsurgery and comprehensive treatment strategies for callosal gliomas / 第二军医大学学报

ABSTRACT

Objective: To investigate the clinical characteristics, microsurgery feasibility and postoperation comprehensive treatment strategy of callosal gliomas, so as to improve the prognosis of patients. Methods: The clinical manifestations, diagnoses, microsurgical approaches, chemotherapy and radiotherapy, and prognoses of 82 callosal gliomas patients, who were treated in our hospital during January 1995 and December 2007, were retrospectively analyzed. The optimal surgical approach and resection strategies were chosen preoperativety according to the imaging features of tumors. Resections were performed and the navigational orientation was used during operation in 8 cases, type-B ultrasonic supervision was used in 4 cases, and cavitron ultrasonic surgical aspirator (CUSA) was used in 5 cases. Patients with tumors above grade U underwent chemotherapy (temposide + semustine) and radiotherapy designated individually according to the pathological grades and involvement of gliomas. The follow-up study was conducted by telephone, mail or outpatient department visits. Results: The clinical manifestations of the 82 patients included headache and vomiting (n=44), epilepsy (n=16), mental symptoms (n=12), and mild plasy (n=20). Resections were performed via the longitudinal fissure approach in 44 cases, via the transcortical approach in 24 cases, and via the longitudinal fissure and transcortical combined approach in 5 patients; 7 patients received stereotactic biopsy and 2 patients only received chemotherapy and radiotherapy. Six patients had tumors found in the rostrum of corpus callosum, 36 in the genu of corpus callosum, 30 in the body of corpus callosum, and 10 in the splenium of corpus callosum. Total surgical resection was performed in 45 cases, subtotal in 13 cases, and partial in 15 case. Pathological findings confirmed astrocytoma in 48 cases, oligodendroglioma in 11 cases, ependymoma in 2 cases, and glioblastoma in 19 cases. The follow-up of 61 patients indicated that 89% patients survived for over 1 year, 71% survived for over 2 years, 62% survived for over 3 years and 39% survived for over 5 years, with a median survival time being 47 months and the longest survival time being 140 months. COX regression analysis found that elder age, higher pathology grade and incomplete resection were associated with poor prognosis. Conclusion: The callosal gliomas locate at especial position, and the anatomic characteristic, adjacent structure, blood supply should be fully understood before operation. Accurate surgical approaches assisted by appropriate therapeutic strategies can improve the prognosis of the patients. The longitudinal fissure approach is commonly used. The proficient microsurgical technique combined with navigation and type-B ultrasonic can improve the resection outcome and prognosis of patients.