立体定向引导氩氦刀靶向冷冻治疗脑胶质瘤

Cryosurgery of cerebral gliomas with cryocare surgical system guided by stereotactic technology

目的探索应用氩氦外科冷冻系统结合脑立体定向外科治疗脑胶质瘤的手术疗效。方法使用CRW立体定向仪，行头顿计算机体层摄影扫描（CT）确定脑胶质瘤中心及边缘点坐标。以氩氦超冷治疗探针在限定靶区进行冷冻－复温－冷冻治疗4例复发性胶质瘤。结果1例直径4．5cm的颞部肿瘤行钻孔肿瘤中心靶点冷冻治疗；余3例直径8～15cm枕顶部肿瘤行主体定向等体积切除手术，术中冷冻后切除冷冻瘤组织。术后CT扫描显示：3例肿瘤组织及肿瘤边缘1cm范围被切除，术后无出血及明显水肿；1例直接冷冻治疗后3周复查见病灶染色消失，CT密度下降，呈软化改变。术后1例轻偏瘫加重，对症处理后恢复，1例头皮切口愈后不良，经皮瓣转移后愈合。结论立体定向引导氩氦超冷刀治疗脑胶质瘤，能较彻底切除肿瘤，手术侵袭性小，安全且易于操作，具有较强的临床应用价值；但此操作技术还不尽完善，远期疗效还有待进一步观察。

Objective To investigate the effects of treating brain glioma patients with cryosurgical system gUided by stereotactic technology. Method Using CRW stereotactic instrument and brain CT to define the center and endge coordinate of brain glioma. The cryocare probe was carried out to treat 4 cases recurred glioma at the limited target by freezing, re-warming and freezing. Result One patients, with the diameter of the glioma was 4.5cm, accepted the cryocare surgery from drilled skull hole with no resection; the other 3 patients, with the diameter of gliomas ranged from 7 to 15cm, were taken stereotaxy-assisted craniotomy and removed the necrotic tissue after cryotherapy. Post-operative CT image showed that all glioma tissue and 1cm of the scope of external tumor tissue were eliminated in 3 cases, No cerebral hemorrhage and remarkable cerebraledema; The case which was carried out directive cryocare surgery was found out that the dye of the focus was vanished and the dense of CT was descended. One patient aggravated mild hemiplegia afer operation, and recovered soon. one patient whose skin incision didn't heal well was carried out the scalp skin-petal transition operation and the skin incision healed quickly. Conclusion Stereotactic guided cryocare surgical system can remove brain tumor totally with less trauma and hemorrhage than the conventional way. It is also a safe method for the management of hrain glioma. So it may have encouraging future in the clinical application, though its long term effects still need to be observed further.