脑转移瘤显微外科切除中术中辅助技术的整合应用进展

Advances in the Integrated Application of Intraoperative Adjunctive Techniques in Microsurgical Resection of Brain Metastases

摘要:

脑转移瘤(Brain Metastasis,BM)是一种继发性脑肿瘤,是成年人最常见的恶性中枢神经系统肿瘤之一,其中位生存期约为6个月。近年来,随着免疫治疗和靶向治疗的不断进展,BM患者的生存率逐步提高,临床治疗策略正由姑息干预转向更积极、个体化的综合治疗。在术前评估方面,分级预后评估体系(Graded Prognostic Assessment,GPA)已被广泛应用于生存预测与风险分层,有助于手术适应证的科学判定。对于适宜手术的患者,术中多种关键技术正逐步融合以提升安全性与切除完整性:神经导航联合纤维束成像可精准规划手术入路并避让重要传导束；皮层下刺激(subcortical stimulation, SCS)可实时监测皮质脊髓束,显著降低术后运动功能障碍风险；术中超声(intraoperative ultrasound, iOUS)技术能即时识别肿瘤边界与残余灶；荧光素钠引导切除可增强肿瘤可视化,提升全切率,且具备成本低、操作简便等优势；同时,针对部分脑转移瘤呈现浸润性生长的新发现,超边缘切除(supramarginal resection)理念被提出,用于进一步降低局部复发率。神经外科在BM治疗中的作用正日益增强,未来应持续推进术前评估与术中技术的协同优化,以实现最大程度的安全切除与长期生存获益。

Abstract:

Brain metastasis (BM) is a secondary brain tumor and one of the most common malignant central nervous system tumors in adults, with a median survival of approximately 6 months. In recent years, with the continuous progress of immunotherapy and targeted therapy, the survival rate of BM patients has gradually improved, and clinical treatment strategies are shifting from palliative intervention to more proactive and individualized comprehensive treatment. In terms of preoperative evaluation, the Graded Prognostic Assessment (GPA) system has been widely used for survival prediction and risk stratification, which helps to scientifically determine surgical indications. For patients who are suitable for surgery, multiple key techniques are gradually being integrated during the operation to improve safety and resection integrity: neuro navigation combined with fiber bundle imaging can accurately plan the surgical approach and avoid important conduction bundles; Subcortical stimulation (SCS) can monitor the corticospinal tract in real-time, significantly reducing the risk of postoperative motor dysfunction; Intraoperative ultrasound (iOUS) technology can instantly identify tumor boundaries and residual lesions; Fluorescein sodium guided resection can enhance tumor visualization, improve total resection rate, and has advantages such as low cost and easy operation; Meanwhile, in response to the new discovery of invasive growth in some brain metastases, the concept of supramarginal resection has been proposed to further reduce the local recurrence rate. In summary, the role of neurosurgery in BM treatment is increasing day by day, and in the future, we should continue to promote the coordinated optimization of preoperative evaluation and intraoperative techniques to achieve maximum safety resection and long-term survival benefits.