经小切口锁孔技术切除幕上病变的临床分析

Keyhole approach to surgical removal of supratentorial lesions: Clinical analysis of 71 cases

目的如何减少并发症,加快术后康复是目前神经外科研究的热点。文中探讨幕上病变手术新方法,减少对组织的创伤,达到微创手术的目的。方法对71例颅内病变患者在MRI、CT等影像学定位或在神经导航的引导下,用直切口锁孔入路,切除幕上病变。结果 71例患者中有70例定位准确,1例偏离骨窗缘外0.5 cm,病灶肉眼下全切除,5例(7.04%)功能区病灶术后神经功能障碍加重,4例完全恢复,1例部分恢复。患者平均住院时间为(11.3±0.9)d,同期神经外科患者住院时间为17.3 d,本组患者输血量平均为(75.8±8.7)mL。平均手术时间为(2.4±0.5)h。结论小切口锁孔入路切除幕上病灶是一种安全有效,损伤小的手术方式。

Objective Reducing complications and accelerate postoperative rehabilitation has been a hotspot in neurosurgery research at present. This study aimed to find a new approach to the surgical treatment of supratentorial lesions, which could reduce damage to the nerve tissue and achieve minimal invasiveness. Methods With the help of MRI, CT and neural navigation, we removed 71 supratentorial tumors in the brain by the straight incision keyhole approach through the small ossicle window. Results Seventy of the 71 tumors were accurately positioned, with only 1 at 0.5 cm outside the margin of the ossiele window. All the tumors were removed totally. Nervous function was aggravated after operation in 5 of the cases in which the lesions were located in the function- al areas, of which 4 were fully and 1 partly recovered. The mean hospital stay of the patients was （ 11.3 ± 0.9） d, as compared with the average hospital stay of 17.3 d in the same period. The intraoperative blood transfusion averaged （75.8 ± 8.7 ） mL, and the mean operation time was （2.4 ±0.5 ） h. Conclusion The straight incision keyhole approach to the removal of supratentorial cerebral tumors is a safe, effective and minimally invasive surgical option.