神经导航在经蝶显微手术中的应用

Neuronavigator－guided transsphenoidal microsurgery

目的 评价神经导航系统在经蝶显微手术中的应用。 方法 在10例经蝶手术中（包括9例垂体瘤和1例脊索瘤）应用StealthStation神经导航系统指导手术操作，如定位中线结构、蝶窦前壁、鞍底等，并用以判断肿瘤切除程度。计算导航术前准备时间和手术时间。 结果 10例平均坐标误差1．14～3．19mm（平均2．30mm）。术前准备时间为9～15min（平均10．3min）。手术时间为98～142min（平均120min）。9例垂体瘤全切7例，次全切除2例；1例复发脊索瘤予次全切除。术后症状改善或无变化7例，3例一过性尿量增多，无其他严重手术并发症。 结论 在经蝶显微手术中神经导航提供实时三维定位，有助于提高肿瘤切除率，降低手术并发症，缩短手术时间。

Objective To evaluate the utility of neuronavigator－guided transsphenoidal microsurgery． Method Ten patients, including nine patients with pituitary adenomas and one patient with chordoma, underwent transsphenoidal surgery in which StealthStation neuronavigator was used to localize anatomic midline, the face of sphenoidal sinus, the floor of sella, and to estimate the extent of lesion－resection． Result Mean fiducial error was ranged from 1．14 to 3．91mm（mean, 2．30mm）． Additional setup time and operative time were 9 to 15min（mean, 10．3min） and 98 to 142min（mean, 120min）, respectively． Total removal was achieved in 7 pituitary surgery, and subtotal removal was achieved in two pituitary surgeries and one chordoma surgery． Postoperatively neurological symptoms were improved or unchanged in 7 patients． There was no severe complication attributable to in accurate localization from the neuronavigational system． Conclusion StealthStation neuronavigator provided realtime localization with three－dimensional information． It was helpful for the total removal and reducing the surgical complications．