钬激光在神经外科手术中的应用——附37例报告

Holmium-YAG Laser in Neurosurgery

目的初步探讨钬激光在神经外科的临床应用及其疗效。方法我院神经外科从2002.3至2005.3进行了37例钬激光辅助下神经外科手术,其中蝶骨嵴内侧室管膜瘤2例、镰旁或矢状窦旁脑膜瘤7例、蝶骨嵴脑膜瘤7例、后颅窝脑膜瘤9例,鞍结节脑膜瘤3例,听神经瘤4例、先天性梗阻性脑积水5例。显微镜下使用Ho∶YAG激光分块切割、气化肿瘤,使用功率平均12W,峰值能量0.5J/脉冲~1.5J/脉冲,脉冲频率5Hz^20Hz,以光纤垂直对准病灶,距靶组织3mm^5mm,均匀扫射,使肿瘤凝固、碳化、汽化,同时用生理盐水冲去残屑,使肿瘤体积缩小,最终显微镜下切除肿瘤。对梗阻性脑积水病人行脑室镜下钬激光辅助第三脑室造瘘术或终板造瘘术,使用功率平均2W-8W,峰值能量0.5J/脉冲~1.5J/脉冲,脉冲频率1Hz^8Hz。结果本法切除颅内肿瘤或行脑室造瘘,尤其配备显微镜、脑室镜,使病变与周围组织显示清晰,能在很小的术野下,随意操纵光纤切割、汽化病变组织,本组37例病人均痊愈出院,32例肿瘤病人中,复查头颅MRI发现1例听神经瘤及1例岩斜区脑膜瘤近脑干处约有5%残留,其余未见肿瘤残留。37例患者均恢复良好。结论钬激光在神经外科有广泛的用途,钬激光适用于颅内肿瘤切除、第三脑室造瘘或终板造瘘术等等,尤其是颅底的巨大肿瘤,在显微镜或脑室镜下使用钬激光更为安全有效。

Objective To evaluate the effect of pulsed Holmium ： Yttrium-Aluminum-Garnet （Ho ： YAG） laser in neurosurgery. Methods Thirty seven patients were accepted neurosurgery with the help of Ho ： YAG laser in the last three years, which included 32 intracranial tumor cases and 5 obstructive hydrocephalus cases. A minimally invasive microsurgical treatment was performed with the help of Ho ： YAG laser for every intracranial tumor patient. Wave length ： 2.10 microns; amplitude： 0.5 - 1.5J/pulse; frequency 5 Hz - 20 Hz; working power 5 W - 20 W. Endoscopic third ventrlculostomy was undergone for obstructive hydrocephalus cases with laser parameters. Wave length： 2.10 microns; amplitude： 0.5 - 1.5J/ pulse; frequency： 1Hz- 5 Hz; working power： 2W - 8 W. Results Thirty six patients had good results without any neurological complications. One patient had a temporarily brain stem function disorder, two meningioms had about 5% remains adjacent to the brain stem . Conclusion Ho ： YAG laser is effective in neurosurgery.