神经导航在神经创伤性疾病急诊微创手术中的应用价值

目的探讨神经导航在神经创伤性疾病急诊手术救治中的临床应用。 方法回顾性分析自2016年5月至2017年3月在福建省神经医学中心接受开颅手术治疗的急诊神经创伤患者的临床资料，术中神经导航辅助为导航组，常规手术为徒手组。比较2组病例的临床基本资料、神经急症类别、影像学特点、GCS评分、入住ICU及总住院时长以及GOS评分情况。 结果68例患者中男性39例，女性29例，年龄19~71岁；导航组16例，徒手组52例。导航组病例的手术时长与平均ICU入住时长相比徒手组短，但2组间差异无统计学意义（P>0.05）。导航组病例术前GCS评分（9.2±4.6）略高于徒手组（7.7±3.2），并且2组间术后24 h GCS评分差异有统计学意义（9.7±4.1 vs. 7.3±3.5，P=0.046）。2组术后3个月的GOS评分间差异无统计学意义（P>0.05）。侧脑室穿刺置管引流的病例，导航组穿刺精度优秀率为83.3%，徒手组为64.3%。 结论神经导航辅助神经创伤性疾病手术救治，对于提高颅内病灶定位及穿刺的精度、缩短手术时间，可能具有帮助，特别是对于狭小脑室穿刺及脑深部血肿的病例。尚需更多的针对性研究来进一步论证。

Effects of neuronavigation-assisted minimally invasive operation in surgical rescue to emergency neurosurgical disease

ObjectiveTo explore the role of neuronavigation in emergency surgical rescue for traumatic neurological disease. MethodsSixty-eight patients received surgical treatment for critical neurological disease between May 2016 and March 2017 were included and divided into navigation group and freehand group. Their general information, category of neurological emergency, radiologic characteristics, duration of ICU and hospital stay, perioperative GCS score and prognostic GOS score were retrospectively analyzed. ResultsThese 68 patients (39 males and 29 females) ranged from 19 to 71 years old. The surgery duration and the average length of ICU stay in navigation group (n=16) was shorter than that in freehand group (n=52), but there was no significant difference between the 2 groups. Preoperative GCS score of navigation group was higher than freehand group and there were significant statistic difference (P=0.046) between the two groups with (9.7±4.1) in navigation group and (7.3±3.5) in freehand group. However, the three-month GOS score was not of significant difference between the two groups. The rate of optimal accuracy of the ventricular draining tube was 83.3% in navigation group and 64.3% in freehand group. ConclusionNeuronavigation-assisted minimally invasive operation may be of help to increase the accuracy of lesion localization and ventricular penetration, and may lead to a decrease in surgery duration, especially in the cases of ventricular narrowing and hematoma in deep brain region.