显微镜下持续导航在邻近重要功能区胶质瘤手术中的应用

The application of microscope continued neuronavigation for resection of malignant glioma in nearby eloquent areas

目的探讨显微镜下持续导航在邻近重要功能区胶质瘤术中实时定位的应用价值。方法 37例脑功能区或邻近重要功能区胶质瘤患者利用显微镜下持续导航实时定位肿瘤与功能区边界,结合DTI与MRI图像融合技术,采用等体积切除的方法切除肿瘤并确定肿瘤切除程度。结果 35例在显微镜持续导航下准确定位肿瘤边界,2例因漂移误差术后复查影像学表现与术中切除程度不符。肿瘤全切28例(75.6%),次全切除7例(18.9%),大部切除2例(5.4%),术后10例原有神经功能障碍加重,6例1个月后恢复至术前水平。结论显微镜下持续导航有助于术中实时明确肿瘤切除范围,配合等体积切除方法可在减少功能区损伤的前提下有效提高肿瘤切除程度。

Objective To explore the value of intraoperative real-time location by microscope continued neuronavigation for resection of malignant glioma in nearby eloquent areas. Methods Results Conclusion Methods Microscope continued neuronavigation was used to define the anatomical and functional boundary of the tumor in 37 cases with glioma near the eloquent areas. Combined with DTI and MRI image fusion, the tumor was volumetric resected. Results Thirty-five cases were performed by microscope continued neuronavigation; the boundary of the tumor was clearly real-time defined. Drift error occurred in 2 cases confirmed by postoperative MRI. Total removal of the tumor was achieved in 28 cases （75.6 %）, subtotal removal in 7 cases （18.9%）, partial removal in 2 cases （5.4%） ; the original neurological dysfunction was transiently aggravated in 10 cases. 6 cases recovered to the preoperative level one month later after surgery. Conclusion Combined with the method of volumetric resection, microscope continued neuronavigation may be very helpful to real-time define boundary of the tumor and increase the degree of tumor resection under the premise of reducing the damage of functional areas.