摘要
目的研究功能神经导航联合术中荧光素钠显像在脑转移瘤手术的应用。方法回顾性分析40例脑转移瘤病例资料,按术中是否使用荧光素钠分为观察组(n=20)和对照组(n=20),术前均完善头部CT、MRI平扫与增强、磁共振血管造影(magnetic resonance angiography,MRA)、磁共振静脉成像(magnetic resonance venography,MRV)、磁共振弥散加权成像(diffusion-weighted imaging,DWI)、磁共振弥散张量成像(diffusion tensor imaging,DTI)等,将术前影像资料导入功能神经系统导航软件,确定肿瘤位置及与重要神经纤维传导束、锥体束、大血管的空间关系,再与头颅多平面CT进行图像融合确定手术导航计划。术前对患者进行荧光素钠过敏试验后,静脉注射小剂量荧光素钠(2mg/kg)。术中将神经导航与荧光素钠联合使用,观察肿瘤与正常脑组织边界进行切除。结果在肿瘤切除与术后Karnofsky功能状态评分(Karnofsky performance status scale,KPS)改善情况,观察组优于对照组,差异具有统计学意义(χ^(2)=6.144,P=0.013;χ^(2)=4.286,P=0.038)。观察组术后新发功能障碍较对照组减少,差异有统计学意义(χ^(2)=4.800,P=0.029)。术后并发症、手术时间与住院时间两组差异无统计学意义(χ^(2)=2.294,P=0.130;t=0.589,P=0.560;t=1.065,P=0.294)。结论功能神经导航联合术中荧光素钠显像在脑转移瘤手术可准确定位肿瘤与正常脑组织边界关系,提高肿瘤切除率,改善患者生活质量与预后。
Objective To investigate the application of functional neuronavigation combined with intraoperative sodium fluorescein imaging in the surgical resection of brain metastases.Methods The clinical data of 40 patients with brain metastases were analyzed retrospectively.Patients were divided into observation group(n=20)and control group(n=20)based on whether sodium fluorescein was used during surgery.Preoperative examinations included routine and enhanced head CT,MRI,magnetic resonance angiography(MRA),magnetic resonance venography(MRV),diffusion-weighted imaging(DWI),and diffusion tensor imaging(DTI).The preoperative imaging data were imported into the functional neuronavigation software to determine the tumor location and its spatial relationship with critical nerve fiber tracts,pyramidal tracts,and major blood vessels.Image fusion with multi-planar CT was performed to formulate the surgical navigation plan.After a preoperative sodium fluorescein allergy test,patients received an intravenous injection of a low dose of sodium fluorescein(2mg/kg).During surgery,neuronavigation was combined with sodium fluorescein imaging to observe and resect the tumor margin from normal brain tissue.Results The observation group showed significantly better outcomes in tumor resection and postoperative KPS score improvement compared to the control group,with statistically significant differences(χ^(2)=6.144,P=0.013;χ^(2)=4.286,P=0.038).The incidence of new postoperative neurological deficits was lower in the observation group,and the difference was statistically significant(χ^(2)=4.800,P=0.029).There were no significant differences between the two groups in postoperative complications,operative time,and hospital stay(χ^(2)=2.294,P=0.130;t=0.589,P=0.560;t=1.065,P=0.294).Conclusions Multimodal functional neuronavigation combined with intraoperative sodium fluorescein imaging can accurately locate brain metastases,define the boundary between tumors and normal brain tissue,tumor resection rates,and improve patients'quality of life and
作者
王忠
张晓军
张瑞剑
韩志桐
陈云照
邢栋
王俊青
杨蔚然
张之龙
宋钰辉
Wang Zhong;Zhang Xiaojun;Zhang Ruijian;Han Zhitong;Chen Yunzhao;Xing Dong;Wang Junqing;Yang Weiran;Zhang Zhilong;Song Yuhui(Department of Neurosurgery,Inner Mongolia Autonomous Region People's Hospital,Hohhot,Inner Mongolia 010017,China)
出处
《中国微侵袭神经外科杂志》
CAS
2024年第6期340-344,共5页
Chinese Journal of Minimally Invasive Neurosurgery
基金
内蒙古自治区卫健委科技计划项目(编号:202201059)
内蒙古自治区人民医院院内基金项目(编号:2019YN04)
内蒙古医科大学联合项目(编号:YKD2023LH082)。
关键词
脑肿瘤
肿瘤转移
神经导航
荧光素钠
brain neoplasms
neoplasm metastasis
neuronavigation
fluorescein sodium
