神经导航辅助显微外科在颅内海绵状血管瘤手术中的应用

Image-guided microsurgery in resection of intracranial cavernous hemangioma

目的 探讨神经导航在手术切除颅内海绵状血管瘤中的作用和方法。方法 采用神经导航技术切除 4 4例共 4 8个颅内海绵状血管瘤 ,以额叶最为多见。结果 在神经导航系统辅助下 ,采用微创技术切除肿瘤 ,全切除率 10 0 % ,无手术死亡。应用微导管定位法纠正脑移位。术后症状改善2 6例 ,与术前相比无变化 13例 ,神经功能障碍较术前加重 5例 ,主要表现为偏瘫加重和失语 ,其中 2例在随访中症状改善。术后随访未见病灶残留和复发。结论 采用神经导航系统可精确定位较小的颅内海绵状血管瘤 ,避开功能区 ,减少手术创伤 。

Objective To study the methods and effectiveness of image guided microsurgery in resection of intracranial cavernous hemangioma. Methods Between July 1997 and January 2001, 44 patients with intracranial cavernous hemangioma, 27 males and 17 females with a mean age of 35 years, among which 5 cases had multiple lesions, underwent image guided microsurgery. The locations of lesions included frontal lobe ( n =14), temporal lobe ( n =12), parietal lobe ( n =6), cerebellum ( n =6), thalamus ( n =5), pons ( n =5), and orbital lobe ( n =1). A small silicon catheter, used as a guider, was implanted to the deep seated lesion (except the brain stem lesions) before excision of the lesion in order to prevent brain shift. Results Total removal of the lesions was achieved in all patients without operational death. Follow up revealed marked improvement of symptoms in 26 case and no change of symptom(s) in 13 cases. 5 cases suffered from additional neurological deficits, mainly exacerbation of hemiparalysis and aphasia, the condition of two of which, however, gradually improved within the period of follow up. No residue of lesion and relapse were found during follow up. Conclusion With the assistance of the image guided surgical system, functional area can be effectively avoided, and surgical injury can be decreased. It is well suited for accurate localization and safe resection of small, deep seated cavernous malformations.