论文部分内容阅读
Despite the improvement in surgical technique, more powerful sources of radiation and development of new chemotherapeutic agents, the prognosis for patients with malignant gliomas remains very poor.One of the most important factors which limits our ability to successfully treat these patients is the diffuse and infiltrative nature of glioma growth.Although extensive radical resection fails to cure the malignant gliomas, it does both improve the quality of life for these patients and increase the duration of survival for selected patients.The extent of surgical excision as judged by postoperative enhancement on MRI was one of the strongest factor for survival.Many retrospective studies have reported that there is an improvement in both median survival and long-term survival with extensive surgical resection for malignant gliomas.Because the reduction of tumor mass provides space for postoperative brain swelling, the extensive resection can be less risky than open biopsy or limit To enable safe and radical resection of malignant gliomas, a number of technical adjuncts to surgery ,such as neuronavigation, intraoperative CT, and fluorescence-guided resection have been used.Even though, the high technologies can reduced the surgical morbidities, the expensive equipments itself could not prevent surgical complication during removing the intrinsic gliomas.The most important factor is surgeons decision whether the tumor mass could be removed safely or not.The second factor is selection of appropriate surgical approach.The third factor is protection of adjacent normal brain parenchyma during the tumor removal.The fourth factor is the time when I stop the tumor removal.The fifth factor is how to dissect the tumor mass from the complicated blood vessels.Last important factor is how to control the active bleeding from the tumor and oozing bleeding from the adjacent infarcted brain parenchyma.