神经外科神经导航辅助显微外科在颅内海绵状血管瘤手术中的应用

目的 探讨神经导航在手术切除颅内海绵状血管瘤中的作用和方法。方法 采用神经导航技术切除44例共48个颅内海绵状血管瘤,以额叶最为多见。结果 在神经导航系统辅助下,采用微创技术切除肿瘤,全切除率100％,无手术死亡。应用微导管定位法纠正脑移位。术后症状改善26例,与术前相比无变化13例,神经功能障碍较术前加重5例,主要表现为偏瘫加重和失语,其中2例在随访中症状改善。术后随访未见病灶残留和复发。结论 采用神经导航系统可精确定位较小的颅内海绵状血管瘤,避开功能区,减少手术创伤,是微创切除颅内海绵状血管瘤的有效辅助手段。

Image-guided microsurgery in resection of intracranial cavernous hemangioma

OBJECTIVE: To study the methods and effectiveness of image-guided microsurgery in resection of intracranial cavernous hemangioma. METHODS: Between July 1997 and January 2001, 44 patients with intracranial cavernous hemangioma, 27 males and 17 females with a mean age of 35 years, among which 5 cases had multiple lesions, underwent image-guided microsurgery. The locations of lesions included frontal lobe (n = 14), temporal lobe (n = 12), parietal lobe (n = 6), cerebellum (n = 6), thalamus (n = 5), pons (n = 5), and orbital lobe (n = 1). A small silicon catheter, used as a guider, was implanted to the deep-seated lesion (except the brain stem lesions) before excision of the lesion in order to prevent brain shift. RESULTS: Total removal of the lesions was achieved in all patients without operational death. Follow-up revealed marked improvement of symptoms in 26 case and no change of symptom(s) in 13 cases. 5 cases suffered from additional neurological deficits, mainly exacerbation of hemiparalysis and aphasia, the condition of two of which, however, gradually improved within the period of follow-up. No residue of lesion and relapse were found during follow up. CONCLUSION: With the assistance of the image-guided surgical system, functional area can be effectively avoided, and surgical injury can be decreased. It is well suited for accurate localization and safe resection of small, deep-seated cavernous malformations.