术中超声在脑血管疾病的应用

目的 采用术中超声观察不同颅内血管性病变的显示情况,探讨术中超声实时定位病灶、指导手术切除的价值.方法 对204例颅内血管性疾病患者行术中超声检查,对动静脉畸形患者寻找供血动脉和引流静脉.对海绵状血管瘤患者剪开硬脑膜切除病变前(术前)、经大脑皮层造瘘到达病灶时(术中)以及病灶切除术后(术后)均行术中导航及术中超声检查,并比较二者定位的准确性.结果 ①术中超声对颅内血管性疾病的显示率为98%,其中对颅内动静脉畸形和海绵状血管瘤的显示率均为100%,动脉瘤的显示率为81%,血管母细胞瘤的显示率为91%.②术中超声对颅内动静脉畸形患者供血动脉及引流静脉的显示率为71%.③术中超声与术中导航在海绵状血管瘤切除术前定位的准确率差异无统计学意义(100%对95%,P=0.244).术中超声在海绵状血管瘤切除术中、术后定位的准确率明显高于术中导航,差异有统计学意义(100%对74%,x2=19.513,P＜0.0001,100%对68%,x2=24.973,P＜0.0001).结论 术中超声对颅内血管性疾病具有较高的显示率,并可准确定位病变,指导手术,缩短手术时间,减少损伤,提高手术的精确性.

Evaluation of intraoperative ultrasound in cerebral vascular disease

Objective To explore the significance of ultrasound in localization tumors and directing operation.Methods Intraoperative ultrasound findings in 204 patients with cerebral vascular disease were analyzed retrospectively.Feeding arteries and draining veins need to be distinguished from normal vessels in patients with arteriovenous malformation(AVM).The findings of cavernous of intraoperative neuronavigator and intraoperative ultrasound before,during and after the resection were respectively compared.Results ①98% cerebral vascular disease can be displayed by intraoperative ultrasound.All of the AVM and cavernous hemangiomas were localized accurately,while 81% of aneurysms and 91% hemangioblastomas were displayed.②Feeding arteries and draining veins and be detected in 71% of AVMs.③The localization accuracy of intraoperative ultrasound tended to be higher than superior intraoperative neuronavigator before resection,but the difference were not significant(100% vs 95%,P=0.244).The localization accuracy of during and after the resection were significantly different between them(100% vs 74%,x2=19.513,P＜0.0001;100% vs 68%,x2=24.973,P＜0.0001).Conclusions Intraoperative ultrasound can display and localize cerebral vascular disease,reduce injury,shorten operation time,and improve the accuracy of operation.