术中介入性超声在神经外科的应用

Application of interventional ultrasound in neurosurgery

目的探讨术中介入性超声在神经外科的应用价值。方法超声引导下对3组实验动物行脑组织穿刺活检及微波消融:(1)对10只健康杂种犬和15只家猫脑组织采用不同型号活检针穿刺活检,并对脑组织行微波消融。(2)对20只Wistar大鼠皮下脑胶质瘤模型行微波消融治疗,消融前后行超声造影检查。另对61例颅内病变患者行超声引导穿刺活检或超声引导定位针定位抽吸置管。结果 (1)本研究结果显示实验动物杂种犬和家猫采用不同型号活检针(18G、16G及14G)穿刺活检脑组织的出血量比较差异无统计学意义(P>0.05)。消融脑组织距天线越近、输出功率高,饱和温度更高。消融后形态近似圆形,随微波功率不同(50W,100s),消融直径在0.8～1.2cm。(2)Wistar大鼠皮下胶质瘤呈边界模糊的低回声区,内见点状血流信号;消融前造影18只均匀增强,2只不均匀增强;消融后内部血流信号消失,造影17只无增强,3只边界不规则增强。61例颅内病变患者中6例脑肿瘤超声引导定位,术者经定位针准确找到病灶;19例脑积水、9例肿瘤囊性变、4例脑脓肿、3例硬膜外血肿患者术中超声引导穿刺成功抽吸减压完成介入治疗。结论介入性超声在神经外科可实时监测,定位准确,有效辅助治疗颅内病变,是颅脑手术的重要补充。

Objective To investigate the value of interventional ultrasound in neurosurgery. Methods A total of the brains from 10 healthy half-bred dogs and 15 domesticated cats were performed by biopsy and treated with microwave output power and ablation duration. The 20 Wistar glioma models were treated with microwave ablation, and took contrast-enhanced ultrasonography before and after ablation. The 61 patients with intracranial lesions had ultrasound-guided biopsy or ultrasound-guided needle localization. Results Blood flows in different types of needle biopsy had no significant differences. The ablation brain organization was apart from the antenna, the output power was high, and the saturation temperature was higher. The shapes were circular after the ablation, and ablation diameters were in 0.8-1.2 cm. The subcutaneous gliomas showed hypoechoic zone with blurred boundary. Eighteen cases were enhanced and two cases were non-uniform enhanced before ablation. Seventeen cases had no enhancement and 3 cases had irregular borders after ablation. Intraoperative ultrasound-guided accurately identified 6 cases of brain tumors. Ultrasound-guided puncture and biopsy were helpful to classify diagnosis and reduce the intracranial pressure. Conclusions The interventional ultrasound in neurosurgery as an important supplement for brain surgery may real-time monitor, accurately locate, and effectively treat intracranial lesions.