神经导航下显微手术切除脑深部病变

Neuronavigator-assisted microsurgery for lesions in deep brain

目的探讨脑深部病变的手术治疗经验。方法在BrainLabVV2神经外科导航系统指导下显微手术切除脑深部直径为8～25 mm大小病变46例。其中脑脓肿4例,脑囊虫病2例,脑膜瘤2例,侧脑室内室管膜瘤1例,胶质瘤22例,海绵状血管瘤7例,血管畸形4例和炎性肉芽肿4例。除脑膜瘤外,其余病灶平均距脑皮质约30 mm。分别利用神经导航系统定出手术切口、骨窗大小,指示手术入路。结果 40例病变全切(87%),6例次全切(13%)。骨窗平均30 mm×40 mm大小;平均导航误差小于1.2m。术后39例患者临床症状改善,7例无变化,无手术并发症。结论在神经外科导航系统指导下手术切除脑深部直径为8～25mm大小病变定位准确可靠,切口和骨窗大小适当,术中合理采用导航与手术分离的方法 ,利用自然沟裂,加之熟练的显微手术操作,可最大限度切除病变,减少副损伤和并发症的发生。

Objective To explore the application of neuronavigator-assisted microsurgery to the resection of the lesion in the deep brain.Methods Forty-six patients with lesions in deep brain,of whom,4 suffered from cerebral abscess,2 cerebral bladder worm disease, 2 meningiomas,1 ependymoma,22 gliomas,7 cavernous arlgiomas,4 vascular malformations and 4 granulomas,were treated by neuronavigator-assisted microsurgery.Bone flap and incision were designed by neuronavigational system.The diameters of the lesions ranged from 8 to 25 mm.The average distance from the lesions to cortexes was 30 mm.Results Of 46 patients,40 received totally resection of the lesions and 6 subtotal.The mean fiducial error was 1.2 mm.Of 46 patients,39 were improved in the clinical symptoms and 7 unchanged in the clinical symptoms.Conclusions The lesions may be located accurately,and bone flap and incision may be designed properly by the neuronaviational system.The hight total resection rate of the intracranial lesions and decrease in the side injury induced by the surgery and postoperative complications may be reached by neuronaviational system combined with skillful mcrosurgical technique.