神经导航下脑胶质瘤切除术及影像漂移的处理

Analysis of resection of neurospongioma under neuronavigator and brain shift.

目的 探讨神经导航系统在脑胶质瘤手术中的应用和手术中影像漂移影响因素及处理方法。方法 根据导航工作站所显示胶质瘤的三维结构，制定手术计划，在观察棒导航下寻找病灶，完成胶质瘤切除术。结果 所有病灶均在导航显微镜下切除。病变体积及手术时间长短对脑组织在手术路径方向的移位有相关性；手术入路的角度及病变的深度与路径方向的移位有相关性；脑室开放后大量脑脊液的丢失对皮层在路径方向及平pan面方向的移位均有影响。结论 神经导航在胶质瘤手术中的应用，可有效地保护神经功能。对于影像漂移，可通过严格导航及手术操作，选择最佳注册点及通过减少脑脊液流失、减少脑组织的切除体积、避免肿瘤囊液的过早释放来预防。

Objective To investigate the application of neuronavigator in the resection of neurospongioma and management of brain shift. Methods Operation protocol was made according to three dimensional structure of neurospongioma under neuronavigation. The focus was sought by using viewing wand for the resection. Results All focus were removed under neuronavigator. The size and operation time was associated with brain shift along the operation pathway. Operative approach and depth of lesion was related to brain shift. Loss of large volume of cerebrospinal fluid exerted influences on the shift of cortex along the operative pathway and plane side. Conclusion Neuronavigator can effectively protect nerve function when used in the resection of neurospongioma. As for brain shift, strict navigation and operative procedure would be useful for reducing loss of cerebrospinal fluid, removed volume of brain tissue and avoiding early release of tumor hydatid flui.