电磁导航与术中实时超声在显微神经外科手术中的应用

目的总结电磁导航与术中实时超声辅助下显微神经外科微侵袭手术的临床应用经验。方法开展神经影像导航辅助下对颅脑不同部位及不同性质病变进行手术切除，其中应用电磁导航辅助下完成显微手术69例，开展术中实时超声辅助下显微手术46例，另外14例手术在电磁导航的基础上综合术中实时超声影像进行位置及切除程度的验证。结果129例病变，116例达到全切除（89．9％），13例为次全切除（10．0％），8例患者神经功能较术前恶化（6．2％），术后新增神经功能障碍发生率为6．2％，术后由于并发症死亡3例（2．3％）。结论神经影像导航辅助下显微外科手术，可以精确定位，设计最佳手术入路，减少神经功能损伤和术后并发症。针对不同的病变和手术要求，灵活使用电磁导航或者术中实时超声能够经济有效的实现神经影像导航辅助下的显微手术。

Application of MRI based on navigation and intraoperative real time ultrasound in microneurosurgery

Objective To review experience of MRI based on neuronavigation and intraoperative ultrasound guidance in minimal invasive microneurosurgery. Methods 129 patients were performed to resect intracranial lesions under image neuronavigator. 69 cases were completed with MRI image based on neuronavigation assistance. 46 cases were completed with intraoperative ultrasonic guidance with ultrasound scanner. Result 116 （89.9%） cases were wholly resected. 13 （10.0%）cases were partly resected. Additional neurological function damages occurred in 8 of 129 patients （6.2%）. 3 patients died of complications （2.3%）. Conclusion Image navigation could assist location, approach design, and decrease operative complication. Either preoperative MRI image or intraoperative real time Ultrasound could economically and effectually realize neuronavigation in microneurosugery.