The Clinical Application and Significance of Contouring the Middle Cerebral Artery Under the Guidance of Three Dimensional Time-of-Flight Magnetic Resonance Angiography During the Surgical Resection of Insular Gliomas.

[OBJECTIVE] The clinical application of middle cerebral artery contouring, guided by the three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) during the surgical resection of insular glioma, was retrospectively analyzed, and its clinical efficacy was assessed.

[METHODS] From January 2017 to February 2021, 67 patients with insular gliomas were treated in the Department of Neurosurgery at Anqing Municipal Hospital (Anqing Medical Center, Anhui Medical University). Patients were divided into 2 groups, including 36 patients who were treated with 3D-TOF MRA-assisted middle cerebral artery contouring surgery (observation group) and 31 patients with craniocerebral transcortical fistula microsurgery (control group). The degree of tumor resection (extent of resection), surgical related neurological dysfunction, and behavioral status score (Karnofsky Performance Status) before and after surgery was compared between the 2 groups. The 3-year progression-free survival (PFS) and overall survival (OS) were also compared between the 2 groups.

[RESULTS] The postoperative extent of resection was 72.2% in the observation group and 32.3% in the control group (P < 0.001). Surgery-related neurological dysfunction was 8.33% in the observation group, while it was 35.6% in the control group (P = 0.001). Follow-up data revealed that for the observation group, PFS was 31.6 ± 0.93 months and the OS was 33.5 ± 1.27 months, while in the control group, PFS was 15.3 ± 1.01 months and OS was 19.8 ± 1.08 months (P < 0.05) CONCLUSIONS: Preoperative 3D-TOF MRA can effectively evaluate the number, shape, and location of the middle cerebral artery and its branches. This method can also guide the exposure and contour of important blood vessels during operation, which facilitates the safe and effective resection of insular gliomas, reduces postoperative neurological dysfunction, and improves clinical prognosis.