神经导航下锁孔入路切除颅内运动区海绵状血管瘤

Surgical Excision of Brain Cavernous Angioma Involving Motor Area by Keyhole-Approach Craniotomy under Neuronavigator

目的探讨神经导航下锁孔入路切除颅内运动区海绵状血管瘤(CA)临床应用价值。方法对12例涉及运动区的CA患者,术前均行颅脑导航薄层(3DT1)扫描及功能磁共振成像(fMRI)。图像融合后,描画出CA,定位运动区,锁孔骨窗开颅,根据导航指引寻找CA,结合术中电生理定位,避开运动区,利用镜内导航引导显微手术切除CA。结果导航仪描画CA后立体呈现出CA的大小、位置,fMRI确定的运动区边界与术中电生理确定的运动区边界基本一致。12例CA均全切除,未出现远期术后功能障碍。结论在锁孔手术中应用镜内神经导航融合fMRI,结合术中电生理定位,最大程度切除运动区CA,同时能有效保护神经功能,减少运动区损伤,提高患者术后的生活质量。

Objective To explore the clinical outcome of microsurgical excision of brain Cavernous Angioma（CA）located in the motor area by keyhole-approach craniotomy under the neuronavigator.Methods Twelve cases of CA involving the motor area were examined by 3DT1 and functional Magnetic Resonance Imaging（fMRI） before the surgery.The images of 3DT1 and fMRI were used to draw CA and locate the motor area.A craniotomy was performed through a keyhole bone window,guided by a neuronavigator,and combined with electrophysiology to avoid impairment to the motor area.Microsurgical excision of CA was guided by a microscopical-neuronavigator.Results The size and site of drawn CA was stereoimaged by the neuronavigator.The boundary of the motor area defined by fMRI was basically consistent with electrophysiology in the surgery.The twelve cases of CA were totally removed,and no postoperative long-term function damage were observed.Conclusion Brain CA involving the motor area can be precisely resected by keyhole craniotomy under a microscopical-neuronavigator combined with fMRI and electrophysiology to locate the motor area.It can maximize CA resection and the protection of the neurological function,minimize the impairment to the motor area,and improve the postoperative life quality of the patients.