术中B超联合神经导航辅助显微手术切除脑功能区及脑深部病变

目的 探讨术中B超联合神经导航在大脑皮层功能区及脑深部病变切除术中的应用价值。方法 回顾性分析2017年12月至2020年12月收治的25例（32个病灶）大脑皮层功能区及深部病变的临床资料。均在术中B超联合神经导航引导下切除病变。结果 术中B超均完整、清晰显示32个病灶，其中29个皮层功能区病灶，术中B超定位与MRI神经导航定位无偏差；而3个深部病灶均有不同程度位移，最大误差约为1 cm。术后MRI显示，22例病变全切除，2例高级别胶质瘤次全切除，1例多发脑结核瘤切除80%。术后神经功能损伤加重及新增副损伤4例。随访截至2021年3月，25例中，失随访2例，其余23例平均随访13.3个月，14例非恶性肿瘤症状明显缓解，3例胶质瘤术后复发、无进展生存期平均13个月，2例肺腺癌转移瘤及另4例胶质瘤未复发。结论 术中B超联合神经导航引导可辅助精准定位大脑皮层功能区及深部病变，但对脑恶性肿瘤的作用有限。

Application of intraoperative B-mode ultrasound combined with neuronavigation in microsurgery for cerebral cortex and deep brain lesions

Objective To explore the clinical value of intraoperative B-mode ultrasound combined with neuronavigation in the resection of cerebral cortex and deep brain lesions. Methods The clinical data of 25 patients (32 lesions) with cerebral cortex and deep brain lesions who underwent microsurgery under guidance of intraoperative B-mode ultrasound combined with neuronavigation from December 2017 to December 2020 were analyzed retrospectively. Results All the lesions were completely and clearly seen by intraoperative B-mode ultrasound. There was no deviation between intraoperative B-mode ultrasound positioning and MRI neuronavigation positioning in 29 cerebral cortex lesions, and displacement in 3 deep brain lesions with a maximum deviation about 1 cm. Postoperative MRI showed that the lesions were totally removed in 22 patients, subtotally in 2 and partially in 1. New neurological damage or aggravated neurological damage occurred in 4 patients. The end of follow-up was at the end of March 2021. Of these 25 patients, 2 patients were lost. The other 23 patients were followed up for an average of 13.3 months. The symptoms were significantly relieved in 14 patients with non-malignant tumors, glioma recurrence was occurred in 3 patients with an average progression-free survival period of 13.3 months, and no recurrenec occurred in 2 patients with lung adenocarcinoma metastasis and 4 patients with glioma. Conclusions Intraoperative B-mode ultrasound combined with neuronavigation guidance can help accurately locate cerebral cortex and deep brain lesions, but it has limited effects on brain malignant tumors.