摘要
目的探讨神经导航结合术中超声的影像引导系统在颅内海绵状血管畸形（ICMs）切除手术中应用的可行性和临床价值。方法2007年1月至2009年12月对40例ICMs患者在术中超声结合神经导航下进行手术，并对其术后情况进行随访。其中男性18例，女性22例；年龄18—58岁，平均34．5岁；所有患者术前均利用神经导航精确显示神经系统和病变组织的三维模型，设计手术人路并确定切口范围；术中实时导航定位病变从而不断验证手术入路的正确性，并辅以术中超声实时监测，引导手术进程，判断病变切除的程度。结果导航注册误差1．3～3．2mm，平均2．0min。所有患者术前神经系统和病变部位的三维建模均较满意，术中均能准确定位颅内病变区。4例在病变切除过程中出现导航漂移现象，漂移程度5．0～10．0mm，术中超声予以矫正。术中实时超声均能对病变显示良好。本组所有病变均全切除，2例术后出现新的神经功能障碍，致残率5．0％，无感染、死亡病例。结论神经导航和术中超声技术在ICMs切除术中的联合运用能够提供关于病变定位和病变切除程度等有价值的术中信息，从而最大程度地实现病变的准确定位和完全切除，减少并发症，提高手术治疗效果。
Objectives To analyze the reliability and clinical value of intraoperative ultrasound combined with neuronavigation for resection of intracranial cavernous malformations. Methods From January 2007 to December 2009,40 cases of intracranial cavernous malformations were operated under the application of intraoperative ultrasound combined with neuronavigation. There were 18 male and 22 female, aged 18 to 58 years, with a mean age of 34. 5 years. Neuronavigation was used for all patients before operation to display the three-dimensional model of nervous system and lesions, so to design the operative approach and determine the scope of the incision. Lesions were allocated by real-time neuronavigation in order to continuously verify the accuracy of operative approach during the operation, supplemented by real- time monitoring of intraoperative ultrasound to guide the process of surgery and determine the extent of resection of lesions. Results The registration error of neuronavigation was 1.3-3.2 mm,with an average of 2.0 mm. All the patients＇ three-dimensional model of nervous system and lesions were satisfactorily displayed, and the area of lesions were all accurately located. Structural brain-shifts occurred in 4 cases in the remove process of the lesion, with shift degree 5. 0-10. 0 mm, and were corrected by intraoperative ultrasound. All lesions were well displayed by intraoperative ultrasound. Gross total resection was achieved in all patients, with no patient infected or dead. Neurological deterioration was seen in 2 patients, the morbidity was 5.0%. Conclusions The combination of neuronavigation and intraoperative ultrasound for resection of intracranial cavernous malformations can provide valuable intraoperative informations of the location and resection level of the lesion, thereby maximize the accuracy of lesion localization and the extent of resection,with less complications and enhanced efficacy of the surgery.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2011年第8期716-719,共4页
Chinese Journal of Surgery
关键词
神经导航
血管瘤
海绵状
中枢神经系统
术中超声
微侵袭神经外科
Neuronavigation
Hemangioma, cavernous, central nervous system
Intraoperative ultrasound
Minimally invasive neurosurgery
