MRI引导立体定向开颅切除脑功能区病灶

MRI guided stereotactic cranial trephination for the removel of the lesion in eloquent brain

目的 :介绍立体定向技术和现代影像学的结合对颅内病灶及其毗邻解剖结构进行精确定位 ,使在切除病灶的同时又防止脑功能区神经功能缺失。方法 :使用Leksell G定向仪后 ,行MRI三维扫描 ,在清楚显示病灶与功能区皮层关系后 ,行开放定向手术。结果 :本组 6 2例位于脑内功能区的病灶 ,均达到全切除 ,未输血 ,无手术死亡。术后病理报告 :脑囊虫 2 4例 ,胶质瘤 12例 ,转移性肿瘤 9例 ,脑脓肿 6例 ,脑膜瘤 5例 ,血管畸形 3例 ,炎性病灶 2例。术后病人偏瘫加重 4例 ,运动性失语 2例 ,手术对侧麻木加重 1例 ,其余病人神经功能均得以保留良好。结论 :功能区病灶切除 ,只有在立体定向技术配合下 。

Objetive:To elucidate the method of the precise location of the lesion in the brain and it's surrounding structure,which assisted with the combination of the stereotactic technology and the morden imageology,in order to shield the neurologic deficit from the resection of the lesion.Method:Leksell-G head frame was affixed to the patient's head and underwent MRI scanning.The cranial trephination was performed after identificated the lesion and it's srruounding eloquent regions of the brain.Result:In this series of 62 patients,all lesion which located in eloquent areas were completely removed,no transfusion and mortality.The clinicopathological examination showed:brain cysticercosis(24 cases),glioma(12 cases),metastatic tumor(9 cases),intracerebral abscess(6 cases),meningioma(5 cases),vascular malformation(3 cases),infection(2 cases),4 patients had increased neurologic deficit of hemiparalysis after surgery,1 patient had increased hemipligia,2 patients developed pronounced aphasia.No more neurologic deficit appeared in all other patients.Conclusion:Among the operations in eloquent areas of the brain,minimized invasive neurosurgry could be achieved only when the stereotactic technology was employed.