神经导航和神经电生理辅助下脑功能区肿瘤手术

目的 探讨脑功能区肿瘤治疗的策略和技巧.方法 分析2008年5月至2009年5月手术治疗的脑功能区41例肿瘤.使用神经导航和神经电生理辅助的有23例(辅助组),未使用18例(未辅助组).未辅助组直接行显微手术切除肿瘤.辅助组采用神经导航、皮层神经电刺激(MEP)、体感诱发电位(SEP)、术中唤醒麻醉等技术确定肿瘤和脑功能区,根据肿瘤和功能区的关系切除肿瘤.结果 未辅助组肿瘤全切4例(22%),3例(17%)次全切,11例(61%)大部切除.术后功能良好6例(33%),无变化2例(11%),10例(56%)功能障碍加重.辅助组肿瘤全切12例(52%),4例(17%)次全切,7例(31%)大部切除.术后功能良好16例(70%),无变化3例(13%),4例(17%)功能障碍加重.两组肿瘤全切率及术后功能障碍发生率差异有统计学意义(P<0.05).结论 在神经导航和神经电生理监测的辅助下,可以做到精确的病灶解剖和脑功能区定位,加上运用娴熟的显微手术技巧,脑功能区的肿瘤也能取得良好疗效.

The strategies and skills of brain tumor surgery in cerebral functional areas assisted with neuronavigation and electrophysiological monitoring

Objective Explore the strategy and skills of tumor resection in functional areas. Method From May 2008 to May 2009,41 cases were studied,among which 23 cases were operated and assisted with neuronavigation and electrophysiological monitoring, 18 cases were treated solely by microsurgery. In navigation group, tomors and functional areas were located by neuronavigation, somatosensory evoked potential( SEP) ,motor evoked potential( MEP) and awake surgery techniques, then removal of tumor was achievedc according to the relationship between tumors and functional areas. Results In no - assisted group,4 tumors (22%) were totally removed, 3 ( 17% ) subtotal removed, 11 (61% ) partialy removed. 6 cases ( 33% ) had good recovery, 2 ( 11% ) no changed, 10 ( 56% ) impaired. In navigation group, 12 tumors ( 52% ) were totally removed, 4 ( 17% ) subtotal removed, 7 (31%) partialy removed. 16 cases ( 70% ) had good recovery, 3 ( 13% ) no changed, 4 (17%) impaired. The ratio of tumor resection in navigation group was much higher than that in no - assisted group ( P < 0. 05 ). The ratio of dysfunction in navigation group was much lower than that in no - assisted group ( P < 0. 05). Conclusions Assisted with neuronavigation and electrophysiological monitoring, the tumor and functional area could be located accurately. With excellent skills, good surgical results could be achieved in most brain tumors in functional areas.