超声在颅脑占位病变术中的应用

Application of intraoperative ultrasonography in cerebral occupying lesion resection

目的探讨术中超声在颅脑占位性病变切除术的应用价值。方法56例经CT、MRI诊断为颅内占位的患者,术前超声经骨窗常规探测,术中超声完整显示整个瘤体的位置、范围、深度、性质以及与毗邻血管的关系,实时监控瘤体切除范围,手术结束前再次探测有无肿瘤和血肿残留。结果①术前超声经骨窗探测,25例颅内占位可显示,显示率45%,可提供肿瘤的位置和大致范围,无法判断肿瘤性质。②术中超声探测,肿瘤显示率100%,所有病灶均可准确定位,并提供最佳入路点。③成功引导术者完成肿瘤切除胶质瘤39例,脑膜瘤2例,海绵状血管瘤3例,脑脓肿3例,脑转移癌5例,炎性病灶3例,垂体瘤1例;探测部位深在的肿瘤11例,其中4例位于小脑髓质,5例位于脑岛周围,2例位于脑室;肿瘤的病理性质不同,其声像图表现各有差异。④超声图像提示的残留肿瘤病灶和血肿均在术中得以证实。结论术中超声可以清晰显示颅内占位的位置、大小、性质以及与正常脑组织的边界,帮助术者准确定位,实时监控肿瘤切除情况,及时发现残留肿瘤和血肿,提高手术成功率。

Objective To study the application method and clinical value of intraoperative ultrasonography in cerebral occupying lesion resection. Methods Fifty-six patients who were diagnosed with intracranial mass by CT or MRI were involved in the study. All patients had the examination of transcranial ultrasonography before operation regularly. The location, scope, extent, character and adjacent tissue of the occupying lesion were observed intra-operative. Residuals of the lesion or hematoma were identified before the operation ending. Results ① Twenty-five focus （45%） were found by trancranial ultrasonography before operation. Location and scope of the occupying lesion were identified roughly but the exact character could not be judged. ②All the focus was disclosed clearly（ 100% ） and located exactly in the operation. The appropriate approach was supplied to the operator. ③ Different types of occupying lesion were guided successfully in the operation, including 40 glioma, 2 meningeoma, 3 angiocavernoma, 3 cerebral abscess, 5 brain metastases, 3 phlegmasia and 1 hypophysoma. Eleven of 56 cases of deep seated lesions were explored, 4 in the medulla of cerebellum, 5 around the insula and 2 in the cerebral ventricle. The sonographic appearance of the lesions differed from the pathology character. ④Residuals of occupying lesion or hematoma were identified and confirmed before the ending of operation. Conclusions Intraoperative ultrasonography could display clearly the location, size, character and boundary of cerebral mass, guide exactly the approach in the operative in real-time and explore the residuals of the lesion or hematoma promptly. It is of great value in elevating the achievement ratio of neurosurgery operation.