计算机体层摄影立体定向在神经外科的应用

目的:应用CT立体定向术对脑深部及功能区的病变进行病理学诊断和治疗.方法:自1990年以来采用CT立体定向技术对68例脑深部和功能区的颅内囊性肿瘤进行了定向病检,排除囊液,瘤腔内放置Omaya管和瘤腔胶体磷酸铬内放疗,功能区脑脓肿定向排脓,脑深部病灶定向病检.结果:31例囊性颅咽管瘤经12～66个月随访,25例(80.7%)瘤腔持续消失,3例较前显著缩小,3例瘤实质增大;7例囊性胶质瘤中,2例25～38个月无复发,5例13个月后相继复发;3例囊性转移癌虽在6～18个月内死亡,但颅内放疗病灶无复发;5例功能区脑脓肿全部治愈而无明显后遗症.22例脑深部病灶20例获得病理学诊断,全组无严重并发症和无死亡率.结论:CT立体定向瘤腔内放疗对治疗脑深部和功能区囊性为主的肿瘤应为首选的治疗方法.

The application of CT-guided stereotactic procedure in neuro- surgery

To investigate the advantage of CT-guided stereotactic procedure for treatment of deeply seated brain lesions or lesions in the functional areas. Method: Sixty-eight patients had been received CT-guided stereotactic operation since 1990. Among them, 5 were abscesses in the functional regions, 22 were deeply-seated lesions, and the other 41 cases were intracranial cystic tumors which had been treated with intracavi-tary radiation with 32 P by inserted an Omaya reservoir after evacuation of cystic fluid and pathologic examinations. Result: In 31 cystic craniopharyngiomas (follow-up ranged 12 - 66 months), the cysts gradually regressed and disappeared in 25 patients ( 80. 7 % ), reduction in diameter in 3 patients and increased in other 3 patients. In 7 patients with cystic gliomas, 2 of them had a complete resolvement of tumor, without any evidence of recurrence in followed up for 25-38 months, however, in other 5 patients the tumor recurred after 13 months. 3 patients with cystic metastatic tumors did not recurred although they died in 6 - 8 months postoperativ-ely. Moreover, 5 patients with abscesses resolved comopletely after evacuations. 20 patients were successfully biopsed in 22 deep-seated lesions. No mortality or severe complication occured. Conclusion: The most appropriate initial surgical management for cystic tumor in functional and deep-seated regions is CT-guided stereotactic intracav-itary radiation, which was a newly developed diagnostic and therapeutic measure in neuro-surgery.