多模态功能神经导航联合术中荧光素钠辅助成像技术在颅内恶性肿瘤手术中的应用

目的研究功能神经导航下联合荧光素钠在颅内恶性肿瘤手术中的作用。方法回顾性分析内蒙古自治区人民医院神经外科自2016-2019年经手术治疗的颅内恶性肿瘤患者50例,术前影像学检查包括头颅电子计算机X射线断层扫描技术(computed tomographty,CT)、计算机体层摄影血管造影(computer tomographic angiography,CTA)、核磁共振(magnetic resonance imaging,MRI)平扫及增强序列及核磁共振血管造影(magnetic resonance angiography,MRA)、磁共振静脉造影(magnetic resonance venogram,MRV)、核磁共振弥散加权成像(diffusion weighted imaging,DWI)、核磁共振灌注成像(perfusion imaging,PWI)、核磁共振弥散张量成像(diffusion tensor imaging,DTI)、核磁共振波谱分析(magnetic resonance spectroscopy,MRS)序列扫描,并在术前将其与博医来功能神经系统导航工作站进行多模态图像融合制定导航计划,术中功能导航联合小剂量荧光素钠(2 mg/kg)进行手术。术中神经导航确定肿瘤的位置及与主要纤维传导束锥体束及大血管的空间关系,以及术中Pentero900蔡司显微镜黄荧光模式下显示肿瘤与正常脑组织的边界进行肿瘤的切除。结果胶质瘤38例,肺癌脑转移瘤10例,肾透明细胞癌脑转移1例,梭形细胞肿瘤1例。术前神经导航定位肿瘤与锥体束的准确率达95%。术后3 d复查头部MRI,与术前病变比较,判断肿瘤的切除程度,本组病灶全切除38例(76%),次全切除12例(24%)。患者6个月生存率为85.9%、12个月生存率为53.1%、18个月生存率为24.5%,生存时间为(15.0±3.2)个月。结论多模态功能神经导航联合荧光素钠染色可以实时定位和标记肿瘤,提高肿瘤切除率,改善脑恶性肿瘤患者的预后。

Multimodal functional neuronavigation combined with intraoperative fluorescein sodium assisted imaging in the operation of intracranial malignant tumors

Objective To investigate the role of multimodal neuronavigation intraoperative and sodium fluorescein-guided techniques in microsurgery for intracranial malignant neoplasm.Methods A retrospective analysis was conducted on 50 patients with intracranial malignant tumors treated by microsurgery from 2016 to 2019 in Inner Mongolia People′s Hospital.Preoperative imaging included computed tomography(CT),computed tomographic angiography(CTA),magnetic resonance imaging(MRI),MRI:MRA,MRV,DWI,PWI,DTI,DTI,MRS sequence scan,and before the operation,they were fused with the functional nervous system navigation workstation of Bo Yilai to make the navigation plan.During the operation,the functional navigation was combined with low dose fluorescein sodium(2 mg/kg)for operation.Intraoperative neuronavigation was used to determine the location of the tumor and its spatial relationship with the pyramidal tract of the main fiber conduction tract and the large blood vessels,and intraoperative yellow fluorescence mode of pentero900 Zeiss microscope showed the boundary between the tumor and normal brain tissue for tumor resection.Results There were 38 cases of glioma,10 cases of brain metastasis of lung cancer,1 case of brain metastasis of renal clear cell carcinoma and 1 case of spindle cell tumor.The accuracy of preoperative neuronavigation was 95%.Compared with the preoperative lesions,MRI of the head was reexamined 3 days after operation to judge the degree of tumor resection.In this group,38 cases(76%)were totally resected and 12 cases(24%)were subtotal resected.The 6-month survival rate was 85.9%,the 12-month survival rate was 53.1%,the 18-month survival rate was 24.5%,and the survival time was(15.0±3.2)months.Conclusion Multimodal functional neuronavigation combined with fluorescein sodium staining can locate and label tumors in real time,improve tumor resection rate,and improve the prognosis of brain cancer patients.