脑部电子计算机体层摄影立体定向手术52例分析

COMPUTERIZED TOMOGRAPHIC STEREOTAXIC SURGERY IN BRAIN

本文报告使用作者自行设计制造的,可供电子计算机体层摄影(CT)、核磁共振(MR)和普通X线摄片定位的JP型多功能立体定向仪行CT立体定向脑深部手术52例。其中16例采用通用计算方法,由辅助性微机求出靶点;另36例配用CT适配器,用测量法直接在CT机上定出靶点坐标。80％以上的病灶位于丘脑基底节平面以下。手术类型包括活检、囊肿吸除、血肿穿刺引流、内放射源注入以及配合开颅的定向激光小病灶切除。在含有诊断性目的手术的36例中,术后均获得确定性诊断。其中10例术前诊断困难或与术后病理诊断不相符合。术后死亡3例,轻偏瘫1例。文中对CT定向手术的作用、定位准确性、病例的选择、手术并发症以及该手术的优缺点进行了讨论。

A JP-model stereotaxic apparatus designed and made by the authors is reported. This apparatus is compatible with CT, MRI and X-ray examinations. Fifty-two CT stereotaxic Procedures have been performed on the lesions deep-seated in brain. The target coordinates were calculated mathematically in 16 cases and were measured directly from CT scan taken with the aid of an adapter in other 36 patients. Over 80% of the lesions were deep at the level of basal ganglia. Operative procedures included biopsy, cyst puncture, evacuation of hematomas and resection of lesions with CO_2 laser. Histological diagnoses were obtained in all patients. Three patients died and 1 patient had mild hemiplegia postoperatively. The accuracy of localization, the indications, complications and advantages of this procedure are discussed.