Microsurgical strategies of glioma located in lateral fissure area

Objective To investigate the microsurgical strategies of glioma located in lateral fissure area.Methods The clinical data of 123 patients with glioma located in lateral fissure area confirmed by pathology,76 males and 47 females,aged 46.2 (4 -75),were retrospectively analyzed.The optimal surgical approach and comprehensive therapeutic strategies were selected according to the imaging features and pathological properties of tumors.Resections were performed by the pterion approach in all cases to remove the tumors,navigational orientation was used in 17 cases,and supervision by B mode ultrasonography was used in 12 cases.The branches of middle cerebral artery and fissure vein were protected carefully.The patients with tumors above grade Ⅱ,confirmed pathologically after resection,underwent chemotherapy( teniposide + semustine or temozolomide) and radiotherapy that was designated individually according to the pathological grade and distribution of the tumors.Follow-up was conducted by telephone,mail or outpatient department visit on 102 of the 133 patients (82.9% ).Results 82 patients (66.7% ) underwent total resection,18 (14.6%) underwent subtotal resection,16 (13.0%) underwent major resection,and 7 (5.7%) underwent partial resection.Postoperatively cerebral vasospasm in 8 cases,brief aphasia and reaction clumsily in 4 cases,muscle strength decline in 3 cases,and epilepsy in 1 case,these patients were submitted to symptomatic treatment with progressive improvement of the above-mentioned signs and symptoms.One patient died of malignant intracranial hypertension.The follow-up showed that 97 patients survived over 1 year,the 5-year survival rate was 25.6%,and the average survival time was 21.7 months.Conclusion The lateral fissure area glioma can be treated through proficient microsurgical technique after the anatomic training,It is the key in the surgery on the lateral fissure glioma to protect the main branches of middle cerebral artery,trunk of middle cerebral vein,and important brain functional areas. Key words: Glioma; Lateral fissure; Microsurgery; Benchmaking; Follow-up studies