超声导航辅助显微神经外科手术(附29例分析)

Intraoperative real-time ultrasonic neuronavigation-guided microneurosurgery: analysis of 29 cases

目的探讨术中超声导航在显微神经外科手术中的应用价值。方法对29例神经外科显微手术中采用实时超声影像引导病变定位,指引手术路径选择,并动态了解病变位置的变化情况、手术切除程度。蛛网膜囊肿6例,脑膜瘤1例,动静脉畸形2例,胶质瘤2例,转移瘤5例,脑内血肿8例,椎管内神经纤维瘤4例,脑脓肿1例。结果所有病变均得到全切,术后病人恢复良好,神经功能保存完好,无额外的神经功能损害和手术并发症。结论术中超声导航操作简便,定位准确,能够实现实时影像导航;与显微神经外科配合能够有效起到降低手术副损伤,提高手术精度的作用。

Objective To investigate the clinical value of intraoperative ultrasound neuronavigation in microneurosurgery for resecting brain or spinal lesions. Methods Twenty-nine patients with brain or vertebral lesions were operated on with the support of real-time ultrasonic imaging. Dissection of the lesion was performed through the sulci and fissures. The best approach to a lesion was based on surface anatomy and the depth of the lesion was determined using sonographic information. Real-time navigation was done sonographically at anytime if needed, during the operation. Alter resection was completed, the cavity borders of lesions were re-examined for estimating the extent of resection. Histopathological diagnoses of the lesions included 6 arachnoid cysts, 1 meningioma, 2 AVMs, 2 gliomas, 5 metastases, 8 intracerebral hematomas, 4 fibroneuroma and 1 brain abscess. Results All the lesions were totally removed and all the patients recovered well after the operation. No additional neurofunctional damage or complications occurred. Conclusion Intraoperative ultrasound navigation is an effective tool for deep-seated brain lesions. Intraoperative ultrasound allows an easy identification of some brain lesions. The real-time mode enables a control of the surgical procedure.