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影像融合神经导航下垂体腺瘤的经蝶窦显微外科治疗
引用本文:周大彪,倪明,贾旺,刘伟明,李欢,贾桂军.影像融合神经导航下垂体腺瘤的经蝶窦显微外科治疗[J].中华神经外科杂志,2011,27(9).
作者姓名:周大彪  倪明  贾旺  刘伟明  李欢  贾桂军
作者单位:100050,首都医科大学附属北京天坛医院神经外科
摘    要:目的 评价影像融合神经导航在复发垂体腺瘤或伴蝶窦气化不良的经蝶窦显微外科手术中的应用价值。方法 4年期间选择24例垂体腺瘤患者接受神经导航下经蝶窦手术,其中再次经蝶窦手术者18例,蝶窦气化不良者6例。利用MRI和CT融合图像制定导航计划和引导手术进程。通过对比手术前后影像学资料判断肿瘤切除程度。结果 所有肿瘤均通过神经导航准确定位和到达。融合图像可同时显示骨性的蝶窦前壁、蝶窦腔、鞍底和软组织性的肿瘤、颈内动脉、海绵窦及其相互关系。肿瘤全切除20例,次全切除2例,大部切除2例。无颅内出血和感染,短暂性尿崩7例,脑脊液漏和动眼神经麻痹各1例。平均随访17.6个月,22例肿瘤全切除或次全切除者未见复发。结论影像融合神经导航适用于复发垂体腺瘤或伴有蝶窦气化不良者的经蝶窦手术,能准确引导手术进程,避免因定位偏差引起的并发症和有利于肿瘤的全切除。

关 键 词:影像融合  神经导航  经蝶窦  垂体腺瘤

Image fusion neuronavigation- guided transsphenoidal microsurgery for pituitary adenomas
ZHOU Da-biao,NI Ming,JIA Wang,LIU Wei-ming,LI Huan,JIA Gui-jun.Image fusion neuronavigation- guided transsphenoidal microsurgery for pituitary adenomas[J].Chinese Journal of Neurosurgery,2011,27(9).
Authors:ZHOU Da-biao  NI Ming  JIA Wang  LIU Wei-ming  LI Huan  JIA Gui-jun
Abstract:Objective To evaluate the value of image fusion neuronavigation in transsphenoidal microsurgery for pituitary adenomas of recurrence or associated with poorly pneumatized sphenoid sinus (PPSS). Method During a four - year period, neuronavigation - guided transsphenoidal microsurgery was performed for selected twenty - four patients with pituitary adenoma. Among them, eighteen cases underwent repeat transsphenoidal surgery;six cases associated with PPSS received primary operation. The fused images of magnetic resonance imaging(MRI) and computed tomography(CT) were utilized for preoperative planning and introperative guidance. The extent of tumor removal was determined by the comparative analysis of preand post - operative radiological materials. Results All lesions were accurately oriented and approached with the aid of neuronavigation. Fused images allowed simultaneous visualization of the bony structures (sphenoid wall and cavity,sellar floor) and soft tissue( tumor, internal carotid artery,cavernous sinus) as well as the relationship between them. Total tumor removal was achieved in 20 patients, subtotal and part tumor removal in 2 patients respectively. There was no intracranial hemorrhage and infection. Postoperative transient diabetes insipidus occurred in 7 patients, cerebrospinal fluid leakage and occulomotor palsy in 1 patient respectively. No recurrence was found in the 22 patients with total or subtotal tumor removal during an average 17.6 months follow - up period. ConclusionsImage fusion neuronavigation is beneficial to transsphenoidal microsurgical removal of either recurrent pituitary adenomas or pituitary adenomas associated with PPSS. It may provide accurate guidance for the procedure, avoid complications due to misdirection and achieve a more radical tumor removal.
Keywords:Image fusion  Neuronavigation  Transsphenoidal  Pituitary adenoma
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