脑内病变导航手术中脑和病变移位规律初探

Brain and Lesion Shift during Neuronavigated Operations in Supratentorial Cerebral Lesions

目的探讨大脑半球脑内病变导航手术中脑和病变移位的规律与对策。方法大脑内病变20例,术中在硬脑膜打开前、后用导航仪测出硬脑膜和脑表面标记点的差值,为病变切除前的脑移位量。对病变边界可辨的13例患者测量病变移位量。分析脑和病变移位的方向、程度及其影响因素。结果术中寻找病变成功率为100%,全切率75.0%。术中脑移位平均9.62(1～16)mm。病变边界可辨者病变移位量平均6.54(0～13)mm。其中,病变向骨窗方向移位者11例,向深部移位者1例。结论对于边界清楚的脑内病变,应用导航的目的主要是准确找到病变。对于边界不清者,要引导术者寻找增强影像所显示的病变边界、引导全切,因此更需注意脑和病变移位问题。脑移位与病变体积、占位效应和颅内压有关。病变移位与脑移位方向一致,移位量小于脑移位量。

Objective To investigate the presenting features and strategy of brain and lesion shift during neuronavigated operations in supratentorial cerebral lesions. Methods During neuronavigated operations of 20 patients with supratentorial cerebral lesions, the amount of brain shift was measured using neuronavigation system. For lesions with clear boundaries, the amount of lesion shift was also measured. The direction, extent and the affecting factors of brain and lesion shift were analyzed. Results All lesions（ 100% ） were found in the first searching attempt. Complete removal rate was 75.0%. The largest brain shift was 16 mm, and the minimum was lmm（ average 9.62 mm）. The largest lesion shift was 13mm, and the minimum was 0 mm（ average 6.54mm） , lesion shift toward surface occurred in 11 cases, toward deep part in 1 case. Conclusions For cerebral lesions with clear boundaries, the aim of applying navigation system is to find lesions directly and reduce brain injury. For lesions without clear boundaries, navigation system is turned to figure out the imaging enhanced border as the guidance of complete removal. Brain shift is associated with the lesion＇s volume, occupying effect and the intracranial pressure. Lesion shift is consistent with brain shift in terms of orientation, and milder than brain shift in terms of the shifting range.