神经导航在颅内海绵状血管畸形显微手术中的应用

The utility of neuronavigation in the microsurgery for cerebral cavernous malformations

目的探讨神经导航系统在颅内海绵状血管畸形（ICMs）显微手术中的应用。方法回顾性分析1995年1月至2010年12月接受显微神经外科手术的47例ICMs病例。1995年1月至2002年1月收治的14例患者，手术未使用神经导航辅助，为常规手术组；2002年2月至2010年12月的33例患者均在神经导航辅助下进行手术，为导航手术组。常规手术组患者根据磁共振成像扫描图像，参考体表及骨性解剖标志进行病灶定位，导航手术组则应用神经导航系统进行定位，于显微镜下切开探查，沿病灶周边的胶质增生带切除ICMs病灶。癫痫患者则根据具体情况切除癫痫灶，需要时同时作海马切除或软脑膜下横切处理。结果所有患者均经显微手术完全切除病灶，患者的神经系统功能不同程度地改善，其中5例患者术后曾有一过性的功能障碍加重，后期均恢复，21例伴有癫痫的患者仅有1例改善不明显，全组无死亡病例。导航手术组病例的开颅骨窗大小（3．6cm）较常规手术组（5．2cm）显著减小（P〈0．01），但麻醉时间延长（164min比197mm，P〈0．01），手术时间与住院天数并没有明显的改变（P〉0．05），手术治疗的效果亦未发现显著不同。结论应用神经导航辅助进行ICMs显微手术，利于减少手术创伤，且有较好的安全性与可靠性。

Objective To evaluate the utility of neuronavigation in the microsurgery for cerebral cavernous malformations. Methods In a retrospective study,47 patients with cavernous malformations were involved from January 1995 to December 2010. Fourteen cases admitted into hospital from January 1995 to December 2002 were treated without neuronavigation （ conventional group）, the focus localization was based on magnetic resonance imaging （MRI） images, anatomic landmarks, and the experiences of the neurosurgeon. In the other 33 cases admitted after February 2002 to December 2010, surgeries were performed with neuronavigation using the Medtronic Stealth Station TREON or TRIA system （ neuronavigation group）. Excision of the cavernomas were all performed mierosurgieally, surrounding gliotic rim and hemosiderin stained tissue were reseeted in the case of epilepsy, and a few patients underwent extended hippocampal resection or multiple subpial transection. Results With the use of neuronavigation, the extent of eraniotomy reduced from 5.2 cm to 3.6 em（P 〈0. 01 ）, and deeper cavernoma focuses could be treated surgically. There were no changes with regard to the mean size of the cavernomas, the mean time of surgery and hospital stay （P 〉0. 05）, but the mean time of anaesthesia was prolonged from 164 min to 197 min （P 〈0. 01 ）. Cavernomas were resected completely in all 47 cases, which was confirmed by postoperative MRI recheck. The conditions of all patients were improved or remain unchanged, and no significant differences in the clinical outcome could be evaluated between the two groups. Conclusions Application of neuronavigation-assisted microsurgery of intracranial cavernous malformations surgery, helps reduce the surgical trauma, and has security and reliability.