术中超声在显微神经外科手术中的应用

Application of intraoperative ultrasound in neurosurgery

目的探讨术中超声技术在颅内病变显微外科手术中的应用。方法显微神经外科手术治疗颅内幕上病变42例,采用术中超声技术确定病变的解剖边界,了解病变与周围结构的关系,确定皮质切口,实时动态监测指导病变切除范围及判断病变切除程度。结果病变定位准确率达100%。全切除38例,次全切除4例。术后病理显示:胶质瘤21例,脑膜瘤6例,颅内血肿7例,转移瘤5例,海绵状血管瘤3例。术后偏瘫加重2例,失语加重1例;未发生与术中超声扫描相关的并发症。术后3个月复查MRI31例,MRI显示病变切除程度与术中超声结果符合28例(90.1%)。结论术中超声作为一种实时、无创、简便的辅助检查方法,可帮助术者精确定位,提高手术安全性和治疗效果,具有很高实用价值。

Objective To evaluate the application of intraoperative ultrasound in neurosurgery.Methods Forty-two patients with intracranial lesions were enrolled in the study.Intraoperative ultrasound was used to locate the anatomical boundary of the lesions,investigate the relationship with the surrounding structures,determine the cortical incision and real-time monitoring,and evaluate the extent to be resected.Results The accurate rate for lesion location was 100%,total removal of the lesions was achieved in 38 cases and partical removal in 4.The diagnosis was established by postoperative pathological analysis,including 21 glioma,6 meningioma,7 intracranial hematoma,5 metastatic tumors,3 cavernous hemangiomas.Unilateral paralysis symptoms and aphasia were aggravated in 2 and 1 respectively.No complications associated with intraoperative ultrasound occurred.Follow-up was performed in 31 patients by MRI for 3 months,and MRI showed that the resection extent was in accord with intraoperative ultrasound in 28 cases（90.1%）.Conclusions Intraoperative ultrasound is a real-time,non-invasive and convenient auxiliary examination and is helpful to pinpoint the lesions and improve surgical safety and treatment effect,thus being of high practical value.