立体定向显微外科开放直视手术治疗颅内小病灶

Stereotactic microsurgery treatment on intracranial small lesions

目的:探讨CT或MRI引导的立体定向开放手术在脑内或重要功能区小型病灶切除中的应用价值。方法:对62例直径为0.5cm^3.0cm的脑深部及重要功能区小型病灶患者采用Leibinger-Fischer的STP立体手术定位系统,通过CT或MRI图像资料的三维重建定位,借助显微外科技术小骨窗开颅切除病灶。结果:所有病灶均定位精确,并一次性切除,无手术并发症及死亡。8例术后出现偏瘫或偏瘫加重,其中6例经治疗在1周内恢复,3例遗留不同程度神经功能障碍,其余的头痛、肢体麻木无力或轻偏瘫病例,均于术后1月~3月内恢复或明显好转。33例癫痫患者26例术后癫痫症状消失,随访4个月~18个月,28例癫痫症状完全消失,5例癫痫发作次数显著减少。结论:对于脑深部或重要功能区的小型病灶切除,立体定向开放显微手术是一种侵袭性小,定位精确,安全且疗效满意的手术方法。

Objective. To discuss the value of CT/MRI introduced stereotactics microsurgery operation on the treatment of intracranial small lesions. Methods. Sixty-two patients with small lesions （diameter 0.5-3.0 cm） in the depth or important functional area of cerebre underwent stereotactic microsurgery operation with Leibinger-Fisher STP system. Through the CT/MRI picture 3D reconstruction location and microsurgery technique, all lesions were resected with small craniectomy. Results： All lesions were located accurately and resected completely. There were no serious complications or death. 8 patients occured hemiplegia or hemiplegia aggravated, 6 cases of them recovered in a week, 3 cases remained neurologic deficits. All the patients with headache, anaesthesia, or lightly hemiplegia recovered or relieved significantly post-operation within 1-3 months. 26 cases of 33 patients with epilepsy relieved completely, and 5 patients alleviated within 4-18 months follow-up. Conclusion： Stereotactic microsurgery operation is a mini-invasive, accurate, safety, and effective method for the resection of small lesions in the depth or important functional area of cerebre.