神经导航系统在成人幕上胶质瘤切除手术中的应用及其对神经功能的保护作用

背景肿瘤的切除程度与患者的预后密切相关.神经导航系统可空间追踪立体定向,使术者能够清楚手术野的准确影像学解剖位置,提高肿瘤切除的手术质量.目的应用神经导航系统对成人幕上胶质瘤实施全切除,并研究其对神经功能的保护作用.设计以诊断和术后神经功能为依据的回顾性研究.地点和对象实验地点北京天坛医院神经外科.对象1997-2/2000-06收治幕上胶质瘤患者85例,男51例,女34例,年龄17～56岁,肿瘤直径1.8～7.0cm.干预干预者为所有作者.所有患者实施肿瘤全切除,手术全过程在导航系统引导与监视下进行.主要观察指标①术后颅脑MRI影像检查.②肿瘤切除后周围组织电镜及病理切片分析.③术后患者以肢体运动功能、语言功能为主的检查结果.结果肿瘤全切76例,近全切5例,大部切除4例.手术后有49例患者出现明显的神经功能障碍,表现为不同程度的肢体瘫痪和(或)语言障碍,不全偏盲,但全部病例在2个月内恢复,无一例患者留有永久性神经功能障碍.所有8例术前偏瘫的患者在术后短期内症状得到明显改善,均下地行走,karnofaky(KPS)从术前的60～70分增加到80～90分.结论应用神经导航系统可对大多数大脑半球不同部位胶质瘤患者做到影像学意义肿瘤全切除,并且不引起患者术后永久性神经功能障碍.

Reactions of theapplication of neuronavigation system on surgical resection of adult supratentorial gliomaand the neuroprotective function

BACKGROUND: The extent of surgical resection of glioma is closely relating with the prognosis.Neuronavigation system could trace and direct dimensionally to improve the surgical quality of carcinoma excision by clearing the accurate imaging anatomic position of the surgical field for the operator.OBJECTIVE: To apply nerve navigation system in the operation of total resection of adult supratentorial glioma and the function of neural protection.SETTINGS and PARTICIPANTS: Settings: Department of neurosurgery of Beijing Tiantan Hospital. Participants: 85 cases of supratentorial glioma admitted from December 1997 to June 2000, in which there were 51 males and 34females aged from 17 to 56 years old with a diameter of tumour of 1.8 -7.0cm, were selected.INTERVENTIONS: All authors were intervenors. Total resection was operated in all patients under the instruction and the surveillance of navigation system.the limb motor function and language function in postoperative patients.RESULTS: There were 76 cases with total resection, 5 cases with nearlytotal resection and 4 cases with resection in most of the part of the tumour. There were 49 cases had obvious postoperative nerve impairment,which manifested with different extent of limb paralysis and/or languageimpairment and incomplete hemianopia; however, all cases were recoveredwithin 2 months with no permanent nerve impairments. The symptoms significantly improved within short periods after the surgery in all 8 cases withpreoperative hemiplegia, which all were able to walk, and the Karnofaky(KPS) score increased from preoperative 60-70 points to postoperative80 - 90 points.CONCLUSION: From the imaging point of view, it could totally resectgliomas on different sites of cerebral hemisphere in most of the patient byapplying neuronavigation system and moreover, no permanent postoperativenerve impairment would be induced as well.