[Microsurgical technique of brain glioma---a report of 183 cases].

BACKGROUND & OBJECTIVE: Prognosis of glioma is still poor, its main treatment is surgery. The extent of tumor resection relates with prognosis. This study was to evaluate the extent of resection, post-operative Karnofsky performance scale (KPS), and survival rate of the glioma patients received microsurgery. METHODS: Records of 183 glioma patients received microneurosurgery were retrospectively analyzed, the extent of resection, post-operative KPS, and survival rate of patients were evaluated. Different microsurgical techniques were applied according to the location of gliomas. En bloc resection was performed for gliomas in non-functional areas by dissecting the tumors along edema area with high-power bipolar electrocoagulation. The tumors in functional areas were separated along cortex sulcus, the central part of tumor was removed firstly, and residual part was resected with low-power electrocoagulation. Gliomas close to important vessels were sucked, and electrocoagulation seldom performed. RESULTS: Among 183 cases of glioma, 85 in non-functional area, 47 in functional area, and 51 close to important vessels. Total and sub-total resection was performed in 163 patients (89.1%). The average post-operative KPS was 74. The KPS was decreased in 23 patients, increased in 44 patients, and stable in 116 patients. Patients were followed up for 12-216 months with an average of 47.8 months. The follow-up rate was 100%. Among 113 patients with long-term follow-up (>/=5 years), 5-year survival rates of low-grade, and high-grade astrocytoma patients were 75.4% (52/69), and 18.2% (8/44). CONCLUSION: Using different microsurgical patterns according to location of glioma, maximal resection of tumor may achieve with protection of neurological function.

[Individualized therapy and outcomes of microsurgery, radiotherapy, and chemotherapy for astrocytoma].

BACKGROUND & OBJECTIVE: Astrocytomas, constitute about 75% of neuroepithelial tumors, is one of the most common primary tumors in central nervous system with fairly high incidence and poor prognosis. Individualized multimodality is the hope for improving prognosis of patients with astrocytoma. This study was designed to investigate the efficiency of individualized treatment of microsurgery, radiotherapy, and chemotherapy for 62 patients with astrocytoma. METHODS: Sixty-two patients with astrocytoma in study group were treated with individualized multimodality of microsurgery, postoperative radiotherapy, and/or postoperative chemotherapy according to in vitro sensitivity assay. After microsurgery, 59 patients accepted radiotherapy, 46 patients received chemotherapy. Fifty patients with astrocytoma in control group were treated with conventional treatment of surgery, chemotherapy, and radiotherapy. After surgery, 31 patients received radiotherapy following by BCNU chemotherapy, while 19 patients accepted BCNU chemotherapy following radiotherapy. Pathologic diagnosis of patients in study group were 19 cases of grade, 32 cases of grade III, and 11 cases of grade IV; in control group were 13 cases of grade II, 28 cases of grade III, and 9 cases of grade IV. Mean follow-up time were 25.8 months, and the outcome was evaluated by MRI, KPS, and survival rate. RESULTS: Tumor total resection rate in study group was 67.7%, while that in control group was 58.0%. There was no significant difference of KPS and survival rate in patients with low-grade astrocytoma between 2 groups, while the outcome of patients with malignant astrocytoma was significantly improved by individualized treatment. In study group, 2-year expectant survival rate of patients with astrocytoma of grade III, and grade IV were 93.7%, and 36.3%, while in control group were 67.5%, and 22.2% (P< 0.05). In glioblastoma patients, median survival time of study group was 18.68 months, while that of control group was 12.83 months (P< 0.01). CONCLUSION: Individualized microsurgery may improve the total resection of astrocytoma, and benefit to postoperative treatment.Individualized radiotherapy/chemotherapy may prevent patients from some complications. Individualized management may improve prognosis of patients with astrocytoma, particularly malignant astrocytoma.