神经导航在颅内肿瘤切除中的应用

目的探讨神经导航在颅内肿瘤切除中的意义. 方法利用MD-2000系列脑立体定向神经导航切除颅内肿瘤28例. 结果转移瘤8例、脑膜瘤10例均全切,胶质瘤全切8例,次全切2例.导航精度(1.5±0.5) mm.手术时间3～4 h.18例随访6个月,7例胶质瘤中3例复发再手术,5例转移瘤出现颅内新病灶,6例脑膜瘤无复发. 结论在神经导航下切除颅内肿瘤,定位准确,提高手术效果.     

神经导航结合术中超声在颅内海绵状血管畸形切除术中的应用研究

目的 探讨神经导航结合术中超声的影像引导系统在颅内海绵状血管畸形(ICMs)切除手术中应用的可行性和临床价值.方法 2007年1 月至2009年12月对40例ICMs患者在术中超声结合神经导航下进行手术,并对其术后情况进行随访.其中男性18例,女性22例;年龄18～58岁,平均34.5岁;所有患者术前均利用神经导航精确...     

电磁导航下颅内肿瘤切除术病人的护理

对12例颅内肿瘤病人应用电磁导航系统行颅内肿瘤切除,住院14～21 d,均临床治愈出院.提出术前做好解释工作、彻底备皮、制订护理计划;术后严密监测生命体征,预防并发症,做好出院指导,对病人康复有积极作用.     

磁共振弥散张量成像在涉及锥体束的脑肿瘤神经导航术中的应用

目的　探讨磁共振弥散张量成像 (DTI)在涉及锥体束的脑肿瘤神经导航手术中的应用价值。方法　 4 9例涉及锥体束的脑肿瘤 ,随机分为实验组 (融合DTI影像导航 )和对照组 (传统影像导航 )。实验组患者应用DTI重建以锥体束为主的脑白质纤维束 ,采用多影像融合技术将DTI与传统的导航影像相融合 ,应用于神经导航手术。结果　 (1)实验组 2 5例 ,对照组 2 4例 ,两组病例术前均衡性良好。 (2 )对照组肿瘤全切率 5 0 0 % ,实验组 80 0 % (P <0 0 5 )。 (3)对照组术后致残率 75 0 % ,实验组 2 0 0 % (P <0 0 1)。 (4)预后评估 :对照组Karnofsky预后评分 (KPS) 6 9 5 8± 2 3 4 9,实验组KPS84 80± 2 3 4 9(P <0 0 5 ) ;对照组优良率 (KPS =90～ 10 0 ) 37 5 % ,实验组 72 0 % (P <0 0 5 )。 (5 )对照组住院时间 2 4 2 5± 8 17d ,实验组 17 89± 5 4 7d(P <0 0 5 )。结论　DTI影像应用于涉及锥体束的脑肿瘤导航手术 ,可提供病灶与邻近锥体束间的三维可视化解剖信息 ,指导肿瘤最大范围切除并有效保护锥体束 ,显著提高肿瘤全切除率 ,降低患者术后致残率 ,缩短住院时间。     

神经导航系统下颅内肿瘤切除术的护理配合

目的总结神经导航系统下切除颅内肿瘤的手术护理经验。方法对在导航系统下行颅内肿瘤微创外科手术的10例颅内肿瘤患者进行全程护理，重点包括术前了解患者病情，术中熟悉手术步骤。结果10例患者手术顺利，术后回访无并发症发生。结论在充分了解手术程序、掌握导航系统相关设备使用的前提下，正确完善的手术护理配合是保证手术成功的关键之一。     

神经导航系统下颅内肿瘤切除术的护理配合

目的 总结神经导航系统下切除颅内肿瘤的手术护理经验.方法 对在导航系统下行颅内肿瘤微创外科手术的10例颅内肿瘤患者进行全程护理,重点包括术前了解患者病情,术中熟悉手术步骤.结果 10例患者手术顺利,术后回访无并发症发生.结论 在充分了解手术程序、掌握导航系统相关设备使用的前提下,正确完善的手术护理配合是保证手术成功的关键之一.     

传统超声显像在颅内肿瘤手术中的应用

目的探讨传统超声显像技术在颅内肿瘤手术中的应用价值。方法以手术治疗的颅内肿瘤患者21例作为超声监测组,手术中于开颅后应用传统超声凸阵探头置脑皮层表面观察颅内肿瘤,确定肿瘤位置、描述肿瘤特征并测量肿瘤体积,协助术者选择手术入路及确定切除范围;术后关颅前即刻查寻有否残余病灶并协助监测再次切除。随机选取同期手术治疗的颅内肿瘤患者20例作为对照组,术中不应用超声监测。随访术后疗效并比较二组致残率。结果超声在手术中对肿瘤位置及物理性质的判断与手术所见一致,肿瘤体积测量与术前CT测值比较无差异,监测组21例颅内肿瘤在超声监测协助下顺利切除,监测组致残率低于对照组。结论传统超声显像技术在颅内肿瘤手术中应用有助于术者深入认识病变、选择最佳入路、有效切除病变,降低术后致残率。     

神经导航下脑肿瘤切除术的手术配合

神经导航下对20例颅脑手术病人进行术前定位、术中实时导航,提高了手术准确性,降低了手术创伤,是神经外科开展的新技术.积极术前访视、密切术中配合是保证手术顺利进行的重要环节.     

神经导航在胶质瘤手术中的应用

对于胶质瘤手术切除是最基本的治疗手段。但由于胶质瘤呈浸润性生长 ,仅凭手术医生的经验决定切除范围 ,不但难以全切病灶 ,肿瘤复发率较高 ;且易损伤正常脑组织 ,造成手术并发症。由于在MRI图像上 ,胶质瘤与周边脑组织存在界限。这种特点为神经导航辅助胶质瘤手术提供了可能。一、资料与方法1.病例资料 :1997年 9月～ 2 0 0 1年9月 ,我们通过神经导航行胶质瘤手术80例 ,男性 48例 ,女性 32例 ;平均年龄40岁。病灶位于大脑半球 70例 ,深部(丘脑、基底节、侧脑室、胼胝体 ) 9例 ,脑干 1例 ;低级别 (WHOⅠ、Ⅱ级 ) 6 2例 ,高级别 (WHOⅢ、…     

臂丛神经的超声影像学研究

目的 采用高频超声观察国人不同位置臂丛神经的正常形态。方法 采用高频超声对11例健康志愿者行右侧臂丛神经检查，并用神经刺激针确认。在臂丛神经通路上缓慢移动超声探头或改变方向，以检查神经的连续性，获得最佳的臂丛神经纵面图和横断面图。所有臂丛神经声像图特征、解剖的变化、进针和神经定位均被记录。结果 11例健康志愿者臂丛神经均能清楚显示，在超声引导下行电刺激均被证实为神经组织。臂丛神经在横断面上表现为圆形或椭圆形的低回声结构，内部由点状回声组成，纵面上表现为线性较强回声结构。结论 高频超声能提供高质量的臂丛神经声像图。     

神经导航系统在脑深部肿瘤显微手术中的应用

目的 评价神经导航系统在脑深部肿瘤显微手术中的应用价值。方法 应用Stealth Navigation神经导航系统对46例脑深部肿瘤手术治疗，术前采用神经影像MRI导航扫描，对病灶进行三维重建，制定显微手术治疗计划，术中实时导航指导手术切除范围，分析治疗效果。结果 肿瘤及其周围结构定位准确，手术全切除39例（84．7％），次全切除3例（6．6％），大部分切除4例（8．7％）；术后症状改善或不变41例（89．1％），症状加重或出现新症状5例（10．9％），无死亡病例。结论 应用神经导航系统可以精确定位脑深部肿瘤，设计最佳手术人路，有助于提高显微手术疗效，防止手术副损伤，降低手术并发症。     

Multimodal neuronavigation and intraoperative ultrasound visualization in the surgery of intracranial tumors

The author presents an analysis of using neuronavigation and intraoperative ultrasound in 317 patients after surgical treatment of intracranial tumors. High efficacy of the intraoperative ultrasound visualization has been shown in the detection of remaining parts of the intracranial tumor, improved radical surgery and less lesion to the brain. The strategy of using neuronavigation and intraoperative ultrasound visualization with the tumor size (volume) taken into consideration has been developed.     

颅内肿瘤切除术后脑血管痉挛的监测研究

颅内肿瘤切除术后脑血管痉挛尚未引起临床的广泛关注,常被误诊断为手术损伤或脑水肿而延误治疗。作者报告了７２例颅内肿瘤手术前后连续进行神经病学和经颅多普勒超声监测结果,３５例（４８．６％）术后出现血管痉挛（轻度１８例、中度１３例、重度４例）,相关因素分析显示年龄、性别、手术入路、肿瘤病理性质、手术时间、术中出血和输血量以及颅内压增高程度均与血管痉挛的发生无关,而ＣＴ蛛网膜下腔出血和脑脊液含血量与血管痉挛发生有关。作者分析血管痉挛的原因和临床特征,强调显微手术减少脑底池含血量对预防血管痉挛的作用,经颅多普勒超声监测是重要的诊断手段。根据神经病学、ＣＴ、经颅多普勒超声和颅内压监测,分清血管痉挛和术后脑水肿的并存或因果关系,有助于确定治疗策略和控制血管痉挛。使用尼莫通对防治血管痉挛和脑水肿造成的脑损害起关键作用。     

高场强术中磁共振成像系统结合神经导航在经蝶垂体腺瘤手术中的初步应用

目的 总结高场强术中磁共振成像(iMRI)系统结合神经导航在经蝶垂体腺瘤手术中的初步经验.方法 自2009年3月至2010年12月,共有31例垂体腺瘤患者进行了经蝶窦入路1.5 T移动磁体双室设计的高场强iMRI及神经导航辅助下的手术.患者年龄29～76岁,平均年龄(47±11)岁;肿瘤大小1.8～7.3 cm,平均(...     

神经导航在经蝶垂体腺瘤手术中的应用

目的 总结神经导航下经蝶手术治疗垂体腺瘤的经验,并讨论其适应证.方法 对2006年1月至2010年12月138例神经导航下经蝶垂体腺瘤手术病例进行回顾性分析.手术适应证包括:既往经蝶手术后复发性垂体腺瘤36例,侵袭型垂体腺瘤45例,位于垂体侧方或深部的微腺瘤45例,蝶窦气化不良4例,颅底异常增厚3例,双侧颈内动脉间距狭窄4例,鼻中隔偏曲1例.结果 复发性垂体腺瘤全切除12例,次全切除9例,术后出现瘤腔血肿2例,脑脊液漏4例,其中3例合并颅内感染,2例合并交通性脑积水,永久性动眼神经麻痹1例,垂体功能低下者3例;治愈9例,缓解8例.侵袭型垂体腺瘤全切除5例,次全切除27例,术后出现脑脊液漏并颅内感染1例,瘤腔血肿1例;治愈2例,缓解22例;侵袭型激素分泌型垂体腺瘤30例均未治愈缓解.微腺瘤45例均为激素分泌型,均全部切除,治愈38例.颈动脉间距狭窄4例和鼻中隔偏曲1例均全切除和治愈.蝶窦气化不良肿瘤全切除2例,次全切除2例,治愈1例.颅底异常增厚肿瘤全切除2例,次全切除1例,治愈1例.结论 神经导航可以使部分经蝶垂体腺瘤切除手术更加准确、安全、有效,在一定程度上扩大了经蝶手术的适应证.

Abstract：

Objectives To summarize the experiences in clinical application of neuronavigation in transsphenoidal microsurgery of specific pituitary adenomas, and to discuss its indications. Methods From January 2006 to December 2010,138 cases of transsphenoidal microsurgery for specific pituitary adenomas under neuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery includes: recurrent or regrowth of residual pituitary adenomas after former transsphenoidal surgery in 36 cases, invasive pituitary adenomas in 45 cases, extremely laterally or deeply situated microadenomas in 45 cases, poor pneumatization of the sphenoid in 4 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, narrow space between bilateral internal carotid arteries in 4 cases, distortion of nasal septum in 1 case. Results In the recurrence group, 12 were totally removed, 9 subtotally removed;postoperative complications included hematoma within the tumor cavity in 2 cases, cerebrospinal fluid (CSF) leakage in 4 cases among which 3 developed intracranial infection and 2 communicating hydrocephalus, oculomotor paralysis in 1 case and hypopituitarysm in 3 cases;9 were cured and 8 remission. In the invasive group, 5 were totally removed, 27 subtotally removed;postoperative complications included hematoma within the tumor cavity in 1 case, CSF leakage and intracranial infection in 1 case;2 were cured and 22 remission. None of the 30 invasive hormone-secreting adenomas were cured or remission. The 45 cases of hormone-secreting microadenomas were all totally removed, among which 38 were cured. Among the poor sphenoid pneumatization group, total and subtotal tumor removal were achieved in 2 cases respectively with only one cured. In the skull base anomaly group, 2 were totally removed and 1 subtotally removed, with only one cured. For the cases with narrow space between bilateral internal carotid arteries and distortion of nasal septum, all were totally removed and cured. Conclusions Transsphenoidal microsurgery under neuronavigation can be applied for pituitary adenomas in above specific indications. It is an accurate, safe and effective approach for specific pituitary adenomas, which can not only expand the indication of transsphenoidal microsurgery for pituitary adenomas, but also reduce the harmful exposure of X-rays for the operating staff.     

术中超声在脑外伤后脑室穿刺中的应用

目的探讨术中超声在脑外伤后脑室穿刺中的应用价值。方法选取脑外伤后需接受侧脑室穿刺术的患者68例,随机均分为2组,对研究组实施超声引导下侧脑室穿刺术,对照组实施传统盲穿术,分别记录每例穿刺成功所需时间、单次穿刺成功情况及每组的术后并发症情况,并对两组结果进行比较。结果研究组一次穿刺成功率为100％（34／34）;手术时间5-12min,平均（6．35±1．51）min;术后无并发症发生。对照组24例一次穿刺成功,成功率70．59％（24／34）;手术时间5-17min,平均（11．21±3．10）min;术后8例（8／34,23．53％）出现并发症,分别为穿刺道出血4例、误穿入对侧脑室2例、反复穿刺致使窦道形成1例及脉络丛损伤1例。研究组与对照组间的一次穿刺成功率、穿刺手术时间及术后并发症发生率差异均有统计学意义（P均〈0．05）。结论在脑外伤患者的脑室穿刺术中,超声引导法穿刺成功率明显优于传统盲穿法,手术时间明显短于传统盲穿法,并可减少并发症的发生,可在临床推广应用。     

Navigated resection of giant intracranial meningiomas based on intraoperative 3D ultrasound

Background

Surgical resection of giant meningiomas may pose different challenges. Normal brain tissue is often compressed to the limit and is vulnerable to further traction. In addition, severe intraoperative bleeding may be a problem as many giant meningiomas are vascularised with deep feeding vessels entering from the skull base. Neuronavigation based on preoperative imaging can be of limited use as there may be extensive brain shifts during surgery.

Method

We have retrospectively evaluated navigated resection based on intraoperative 3D ultrasound in a series of 15 giant meningiomas with a diameter of more than 5 cm. A pre- and postoperative MRI was preformed in all patients. Preoperative and postoperative neurological function was assessed.

Findings

We were able to safely perform ultrasound-guided intracapsular gross total resection of tumour tissue in all patients. Twelve out of 15 patients were radically operated (Simpson grade I and II). Major feeding arteries and adjacent normal arteries could be identified by ultrasound power Doppler angiography. In one patient we were not able to indentify important venous structures. All patients experienced postoperative improvement of their symptoms. Postoperative MRIs did not reveal significant ischemic changes in adjacent normal brain tissue. The mean duration of hospitalisation after surgery was 4.9 days.

Conclusion

We present a method of ultrasound-guided resection of giant meningiomas. The method enables image-guided resection through narrow approaches that minimise traction. Power Doppler angiography allows the identification of feeding vessels that may be coagulated to limit bleeding. Likewise, normal arteries can be avoided during surgery. The tumour capsule is often surprisingly easy to remove from the arachnoid membrane after gross intracapsular tumour reduction.