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脑的立体定向术是利用立体定向仪通过几何学的座标原理建立座标系,对脑深部结构或病变行立体定位和/或导向的方法。最初是以常规X线技术定位,行定向手术治疗帕金森氏病、癫痫、血肿清除以及埋藏胶囊或放射性材料等。现在,随着CT装置的普及,也已发展了CT立体定向系统。本文讨论189例常规立体定向术的体会。 相似文献
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脑立体定向手术护理 总被引:4,自引:0,他引:4
脑立体定向手术是利用立体定向仪 ,将手术器械如脑穿刺针 ,射频或双电极 ,脑组织活检针 ,引流等等 ,通过颅骨钻孔送到脑深部 ,某些病变结构中进行手术 ,以达到减轻或消除颅内压迫症状 ,消除血肿 ,抽出其中瘤囊液 ,脑立体定向手术方法简便准确 ,脑组织损伤小 ,术后并发症少 ,自1997年至 1998年 3月应用立体定向治疗高血压性脑出血16例 ,男 10例 ,女 6例 ,年龄在 46~ 71岁 ,收到良好的治疗效果。1 手术方法 我院引进国产BH -Ⅲ型立体定向仪 ,局麻下常规CT引导立体血肿排空手术 ,根据坐标植 ,安装定向仪导向系统 ,固定导向穿刺针避开脑… 相似文献
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《中国中西医结合影像学杂志》2017,(5):575-577
目的 :探讨框架立体定向手术计划系统在脑内血肿中的应用。方法 :选择自发性脑内血肿患者64例,随机分成框架立体定向组(观察组)31例和开颅血肿清除组(对照组)33例。应用手术计划系统结合CT扫描数据,将CT图像与立体定向仪融合,计算靶点坐标,设计手术方案,辅助尿激酶溶吸术。观察并对比2组临床疗效。结果:入院时2组神经功能斯堪的纳维亚卒中量表(SSS)评分,差异无统计学意义(P0.05)。治疗2周时,SSS评估,观察组神经功能恢复明显好于对照组(P0.05)。随访1个月时,日常生活能力分级评定,观察组神经功能恢复明显优于对照组(P0.05)。依据手术方案实施精确定位的立体定向手术,能够达到满意的临床治疗效果。结论:立体定向手术计划系统能精准定位脑内血栓,辅助尿激酶溶吸术效果显著,与手术清除血肿比较,能有效提高临床疗效,降低并发症风险。 相似文献
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脑立体定向手术5 100例临床研究 总被引:2,自引:0,他引:2
目的 探讨脑立体定向手术的手术特点、手术适应证及并发症等问题.方法 总结5 100例 (年龄2个月至90岁) 手术的临床经验,主要手术包括:脑肿瘤的内放疗 (植入同位素胶体32P或籽粒125Ⅰ、192Ⅰr)、脑内血肿排空、脑深部病变活检、脑内深部核团毁损、脑深部金属异物摘除和神经干细胞移植术等.结果 临床施行立体定位脑手术5 100例,本组手术一次定位成功率 99.8%,手术总有效率(术后1个月)81.1%;手术并发症以穿刺道出血为主,共13例 (0.25%).结论 本组立体定向手术与常规开颅手术比较,具有操作简便、手术创伤小、疗效可靠、患者术后恢复快、并发症少等优点,在神经外科手术中具有较大的发展前景. 相似文献
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锁孔手术是指经过头部体表微小切口入路,达到颅内深部靶区进行显微神经外科手术。锁孔手术是现代神经外科追求微创而发展起来的新技术,是显微神经外科发展的新高度。锁孔手术在处理颅底及肺深部病变的可行性及微创性已得到公认。我院2003年3月~2008年2月应用锁孔手术切除听神经瘤11例,取得满意效果.现报道如下。 相似文献
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CT引导立体定向脑深部病变活检方法的研究 总被引:1,自引:0,他引:1
采用CT引导立体定向技术对241例脑深部病变行活检术。用153例,女88例。病变在鞍区44例,基底节43例,脑深部或脑主要功能区55例,第三脑室后脑35例,颅内多发病灶28例,脑室内17例,小脑半球内13例,脑干内6例。病变累及范围直径1.0-8.5cm,平均3.5cm,实质性病灶多在2.0cm以内。 相似文献
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作者用内窥镜激光立体定向术治疗了12例脑深部及功能区病变。其中切除脑肿瘤6例;去除脑脓肿2例;脑寄生虫摘除1例;颅内金属异物摘除3例。所有病例进行了内窥镜直视下的活检。取得较好的临床效果。认为此种手术具有创伤小,直视下操作及并发症少等优点。 相似文献
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Intraoperative MR imaging guidance for intracranial neurosurgery: experience with the first 200 cases 总被引:9,自引:0,他引:9
Schwartz RB Hsu L Wong TZ Kacher DF Zamani AA Black PM Alexander E Stieg PE Moriarty TM Martin CA Kikinis R Jolesz FA 《Radiology》1999,211(2):477-488
PURPOSE: To review preliminary experience with an open-bore magnetic resonance (MR) imaging system for guidance in intracranial surgical procedures. MATERIALS AND METHODS: A vertically oriented, open-configuration 0.5-T MR imager was housed in a sterile procedure room. Receive and transmit surface coils were wrapped around the patient's head, and images were displayed on monitors mounted in the gap of the magnet and visible to surgeons. During 2 years, 200 intracranial procedures were performed. RESULTS: There were 111 craniotomies, 68 biopsies, 12 intracranial cyst evaluations, four subdural drainages, and five transsphenoidal pituitary resections performed with the intraoperative MR unit. In each case, the intraoperative MR system yielded satisfactory results by allowing the radiologist to guide surgeons toward lesions and to assist in treatment. In two patients, hyperacute hemorrhage was noted and removed. The duration of the procedure and the complication rate were similar to those of conventional surgery. CONCLUSION: Intraoperative MR imaging was successfully implemented for a variety of intracranial procedures and provided continuous visual feedback, which can be helpful in all stages of neurosurgical intervention without affecting the duration of the procedure or the incidence of complications. This system has potential advantages over conventional frame-based and frameless stereotactic procedures with respect to the safety and effectiveness of neurosurgical interventions. 相似文献
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PURPOSE: To describe prospective stereotaxy, a novel method of trajectory alignment that works in real-time. MATERIALS AND METHODS: Prospective stereotaxy was used in minimally-invasive neurosurgical procedures in 74 patients since February 1999. This methodology differs from framed and frameless stereotaxy, both of which are based on retrospective data. Rather, prospective stereotaxy uses real-time MR images to align a surgical trajectory. RESULTS: Phantom tests and clinical procedures in all patients were successfully performed using prospective stereotaxy. In all cases, surgical targets were accessed, and the diagnostic yield of neurobiopsy using prospective stereotaxy was 100%. CONCLUSION: Prospective stereotaxy is applicable to all cross-sectional imaging, and is particularly useful for MR- and CT-guided interventions. The method is simple, reproducible, and accurate in surgical targeting for neurobiopsy and electrode placement. It does not require cumbersome stereotactic frames or expensive optical detectors, and it offers immediate entry into the field of interventional MR with cylindrical MR scanners. 相似文献
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Lee TH Choi CH Park KP Sung SM Lee SW Lee BH Kim DH Kim HJ Kim CW Kim S 《AJNR. American journal of neuroradiology》2005,26(6):1375-1380
BACKGROUND AND PURPOSE: In some patients with stenosis of an intracranial artery, navigating the balloon or stent-delivery system is difficult of tortuous anatomy of the aortic arch, carotid arteries, or vertebral arteries Our purpose was to describe techniques of intracranial stent placement that help in navigating the stent-delivery system in tortuous vessels. METHODS: Between May 1998 and June 2004, 73 symptomatic stenotic (>50%) intracranial arteries were successfully treated with stent-assisted angioplasty. In 11 cases, standard techniques of navigating the stent-delivery system into the intended lesion failed because of vascular tortuosity. In these difficult cases, several techniques were used to overcome the tortuosity. Five lesions were located in the middle cerebral arteries, four were in the supraclinoid internal carotid arteries, and two were in the distal vertebral arteries. RESULTS: In all difficult cases, stents were successfully placed in the intracranial artery by using several techniques: 1) waiting method in which we waited for 20-30 minutes after advancement of the microwire across the lesion, 2) the double-wire technique, and 3) the coaxial double-guiding catheter technique. The waiting method made smooth stent navigation possible in five cases, the double-wire technique was successful in four cases, and the coaxial double-guiding catheter technique was effective in two cases. No technique-related complications occurred. CONCLUSION: In difficult cases in which standard techniques of navigating the stent-delivery system into the intended lesion fail because of vascular tortuosity, our techniques were useful methods for intracranial stent navigation. 相似文献
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We assessed the clinical value of MR ventriculoscopy (virtual endoscopy, VE) combined with image-guided frameless stereotaxy for endoscopic surgery of occlusive hydrocephalus and intracranial cysts. VE was obtained in 20 patients with hydrocephalus and three with intracranial cysts. All surgical operations were endoscopic. The path of the rigid endoscope to the target point was planned using neuronavigation. VE was carried out along the same trajectory retrospectively in 20 cases and prospectively in three. The results were analysed for demonstration of anatomical landmarks and structures at risk. VE was successful in all patients. Possible obstacles to endoscopic access to the lamina terminalis and the basal cisterns and structures at risk, such as the basilar artery, were clearly shown in relation to the direction of the endoscope. However, the floor of the third ventricle and septum pellucidum were not clearly seen and possible abnormalities could therefore not be appreciated. VE can provide realistic simulation of endoscopic third ventriculostomy and cystostomy. The appropriate trepanation point and trajectory of the endoscope can be assessed with regard to the size of the foramen of Monro and the position of vulnerable structures. This simulated trajectory can be adapted to the field of operation by image-guided neuronavigation. This regime may potentially reduce the risk of damage to intracranial structures. 相似文献
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Introduction Tortuous vasculature is a cause of failure of endovascular treatment of intracranial vascular lesions. We report our experience of direct cervical accesses in patients in whom the arterial femoral route was not attainable.Methods In this retrospective study, 42 direct punctures of the carotid or the vertebral arteries at the neck were performed in 38 patients. The vessel harboring the intracranial lesion was punctured at the neck above the main tortuosity, a sheath was then positioned under fluoroscopic control to allow a stable access to the intracranial circulation. After the procedure, the sheath was removed and hemostasis was gained either by manual compression or by an arterial closure device (4 of 42, 9%).Results The cervical route allowed access to all intracranial lesions in all 42 procedures. A complication was encountered in six procedures (14%) related to the direct puncture. In 2 of the 42 procedures (4%), a transient vasospasm was encountered. A cervical hematoma formed in 3 of the 42 procedures (7%) after sheath withdrawal (one patient in whom an 8F sheath had been used, required surgical evacuation of a hematoma compressing the upper airways; the other patients did well without surgical evacuation). In the remaining patient (1 of 42 procedures, 2%), a small asymptomatic aneurysm at the puncture site was seen on the follow-up angiogram.Conclusion Direct cervical arterial approaches to accessing the intracranial circulation is effective in patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters. 相似文献
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Intracranial alveolar echinococcosis: CT and MRI 总被引:1,自引:0,他引:1
A. H. Bensaid J. L. Dietemann M. M. Filippi de la Palavesa A. Klinkert B. Kastler A. Gangi G. Jacquet F. Cattin 《Neuroradiology》1994,36(4):289-291
Intracranial alveolar echinococcosis is uncommon. We report a patient with right frontal lobe and palpebral lesions secondary to a primary hepatic focus with secondary lesion in the lung. The intracranial and palpebral cystic masses were totally removed and both proved to be alveolar hydatid cysts. An unusual feature in this case is CT and MRI demonstration of dural and bony extension. 相似文献
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目的探讨神经内镜治疗相关颅内疾病的适应证、手术方法及疗效。方法应用微创技术治疗颅内疾病54例,根据不同的病种分别选择不同的手术方式:包括三脑室底造瘘术、蛛网膜囊肿造瘘或剥离术、透明隔囊肿双向造瘘术、肿瘤切除术等。结果16例婴幼儿脑积水术后临床症状缓解,脑积水不同程度减轻。24例蛛网膜囊肿术后颅内高压缓解,囊肿缩小14例,无变化10例。5例透明隔囊肿术后不同程度缩小,3例术后症状消失,2例尚有症状。6例垂体腺瘤术后症状缓解,5例内分泌症状减轻,2例有肿瘤复发趋势。3例脑室内实性肿瘤,术后6月1例死亡,l例肿瘤复发,1例无变化。结论神经内镜治疗颅内疾病重在病种选择。以处理脑积水和囊性病变效果最佳,且主要以造瘘术为主,深部病变宜配合立体定向技术为好,单纯用内镜处理实性肿瘤较为困难。 相似文献