Abstract:

Background: In insular glioma surgery, accurately localizing the lateral surface of putamen remains challenging. This study aimed to explore a water dissection-based technique for sculpting the lateral surface of putamen during insular glioma surgery. Methods and Results: Total 17 patients with insular glioma hospitalized in the Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital from January 2020 to December 2024, all of the tumor were not involved in the putamen and the tumor was resected by trans - frontal isthmus approach. A self - constructed low - pressure water flow system was used to separate the Sanai-Berger zoneⅠ(2 cases), Ⅰ + Ⅳ(6 cases), andⅠ + Ⅳ + Ⅲ +Ⅱ (9 cases). The bottom of the tumor was easily separated from the lateral surface of the putamen, and the lenticulostriate artery exposed on the lateral surface of the putamen was not damaged during the operation, and the separation process was smooth. Within 24 h after surgery, MRI showed the separation of the lateral surface of the putamen from the tumor was appropriate, the lateral surface of the putamen was sharp and regular, and the tumors were nearly completely removed, and the separation effect was good. No complications related to water dissection occurred. At 3 months follow - up, aphasia quotient (AQ) was > 93.80, the operative related side muscle strength was > 4⁺, and Karnofsky Performance Status (KPS) median score was 90 (90, 100). Conclusions: For low - grade insular gliomas without putamen involvement characterized by "Jing -Wei River sign", water dissection effectively delineates the tumor-putamen surface, reduces surgical difficulty, shortens the learning curve, and enhances safety and efficiency.

Key words: Glioma, Water dissection (not in MeSH), Neurosurgical procedures

摘要：

研究背景: 岛叶胶质瘤手术中精准把控壳核外侧面位置是一项挑战，常未达到壳核外侧面或侵入壳核。本研究旨在探索一种基于水分离技术的岛叶胶质瘤手术中壳核外侧面分离方法。方法与结果: 纳入2020年1月至2024年12月在解放军总医院第一医学中心经额峡部入路切除岛叶胶质瘤的17例患者，均未累及壳核，术中采用自行组建的低压水流系统水分离肿瘤底面与壳核外侧面，包括Sanai-Berger分区Ⅰ区2例、Ⅰ区+ Ⅳ区6例、Ⅰ区+ Ⅳ区+ Ⅲ区+ Ⅱ区9例，均较易分离，未损伤豆纹动脉；术后24 h内经MRI证实精准分离肿瘤与壳核外侧面，肿瘤均近全切除，壳核外侧面锐利规整，分离效果良好；无一例发生水分离相关并发症。术后3个月随访，失语商均> 93.80分，手术相关侧别肌力均> 4⁺级，Karnofsky功能状态评分90(90，100)分。结论: 对于存在壳核外侧面“泾渭分明征”的低级别岛叶胶质瘤，水分离技术可以精准分离肿瘤底面与壳核外侧面界限，降低手术难度、缩短手术学习曲线、提高手术效率和安全性。

关键词: 神经胶质瘤, 水分离(非MeSH词), 神经外科手术