摘要
目的探讨术中实时超声导航在椎管内病变手术中的应用价值。方法对36例椎管内病变患者施行术中实时超声导航辅助下显微外科手术。所有手术均采用后正中入路、传统椎板切除术，利用超声影像对病变部位进行术中定位，并在实时超声导航辅助下开展显微外科手术处理病变。结果术中实时超声导航准确定位了椎管内病变及其范围。对于24例占位性病变．手术全切21例，大部分切除3例，病理诊断包括髓内胶质瘤3例、脂肪瘤2例、脊膜瘤2例、神经鞘瘤13例、骶管囊肿3例、结核瘤1例。另有12例脊髓空洞症无病理报告。术后2周症状体征改善者22例，稳定者11例，手术后出现新的神经功能损害症状或者加重者3例，无死亡病例。结论显微神经外科手术是椎管内病变目前最有效的治疗措施。术中实时超声可以实现实时神经导航，有助于提高椎管内病变手术的精确性和全切除率，减少手术并发症。
Objective To evaluate the application value of intraoperative real-time ultrasound-assisted microsurgery for the treatment of patients with intraspinal lesions. Methods The 36 cases undergoing intraoperative real-time ultrasound-assisted microsurgery for the treatment of their intraspinal lesions included 21 males and 15 females, with age ranging from 12 to 64 years （median： 38.6 years）; their disease courses ranged from 1 month to 20 years, 23 months on average. Traditional laminotomy was performed to expose the bone via the posterior midline approach. Before dura mater incision, ultrasound imaging was applied to locate lesions and microsurgery was performed with the assistance of real-time ultrasound-based navigation to treat these pathological changes. Results Intraspinal lesions and their scope were precisely located with the assistance of intraoperative real-time ultrasound. As for space occupying lesions, total resection was achieved in 21 cases and partial resection, in 3 cases. Postoperative pathological diagnosis showed 3 cases of intramedullary gliomas, 2 cases of lipomas, 2 cases of meningiomas, 13 cases of neurinomas, 3 cases of sacral canal cysts and I case of tuberculoma, no pathological reports were obtained for the 12 cases with syringomyelias. Within the postoperative two weeks, symptoms and signs were improved in 22 cases and stabilized in 11 cases, new neurological deficits occurred or worsened in 3 cases and no death was detected. Conclusion Microneurosurgery is by far the best option for intraspinal lesions. Neuronavigation can be realized by intraoperative real-time ultrasound, which may help to enhance the accuracy and total resection rate of microsurgery for intraspinal lesions and decrease surgical complications.
出处
《中华神经医学杂志》
CAS
CSCD
2008年第1期62-64,共3页
Chinese Journal of Neuromedicine
关键词
脊髓
术中实时超声
神经导航
显微外科手术
Spinal cord
Intraoperative real-time ultrasound
Neuronavigation
Microsurgery
