术中磁共振成像在经鼻-蝶入路垂体瘤切除术中的应用研究

目的探讨术中磁共振成像结合神经影像导航系统在经鼻-蝶入路垂体肿瘤切除术中的应用价值。方法采用术中MRI扫描辅助神经导航系统指导经鼻-蝶入路垂体肿瘤切除范围,分析术中MRI对手术过程和患者预后的影响。结果术中MRI扫描系统平均扫描(2.11±0.41)次,所需时间15～20min/次;手术时间共延长47～60min,平均(51.20±0.66)min。38例患者术中MRI共发现11例存在肿瘤残余,其中8例于更新神经导航计划后进一步扩大手术范围全切除肿瘤,3例因肿瘤质地坚韧且与周围解剖结构粘连紧密,仅行部分切除;初次全切除率为71.05%(27/38),在术中MRI导航系统辅助下最终全切除率达92.10%(35/38),提高了21.05%(8/38;χ2=4.290,P=0.018)。术后无一例发生与磁共振检查相关性并发症。结论经鼻-蝶入路垂体肿瘤切除术中应用MRI结合神经导航技术,为指导手术进程及实时判断手术效果提供了客观依据,从而避免了因术中脑组织漂移造成的术前导航偏差,提高肿瘤全切除率。

Research on the application of intraoperative magnetic resonance in transnasal-sphenoidal surgery for pituitary adenoma

Objective To discuss the application of the intraoperative magnetic resonance imaging (iMRI) based neuronavigation system in transnasal sphenoidal surgery for pituitary adenoma. Methods Thirty eight pituitary adenomas were resected via nasal sphenoidal approach with assistance of the American GE Signa 1.5T intraoperative magnetic resonance system associating German Brain LAB neuronavigation system. The clinical materials, iMRI quality and its influence on the surgical process and results were analyzed. Results Intraoperative scanning was performed 2 or 3 times in each patient, averaging (2.11 + 0.41) times. The scanning time was 3-5 min, and adding the packaging and transporting process, the whole procedure required 15-20 min. Posing the position, fixing the head rest and navigation registering took 32-40 min in all. So the total operation may last 47-60 min, averaging (51.20 + 0.66) min. The iMRI was used to scan and collect pictures. Residual tumor tissue was revealed in 11 cases. Eight of the 11 cases underwent total resection according to the new neuronavigation plan. The other 3 cases under went subtotal resection because the adenomas were tenacious and adhered closely to the surrounding significant structures. By using this iMRI system, the total resection rate (TRR) of adenoma increased from 71.05% (27/38) to 92.10% (35/38). It was raised by 21.05% (8/38; χ 2 = 4.290, P = 0.018). There was no iMRI related complication occurred. Conclusion The application of iMRI based neuronavigation technology in transnasal sphenoidal operations for pituitary adenoma provides objective evidence for the guidance of surgical procedure and real time assessment of surgical results, which may lead to higher TRR and avoid deviation of navigation caused by brain drift in transnasal sphenoidal operation.