微创手术在神经外科中的应用价值研究

Clinical evaluation of minimally invasive neurosurgery

目的 探讨微创手术在神经外科中的应用价值。方法 1999年11月至2001年8月本组进行微创手术364例,其中无框架脑立体定向手术177例,微骨孔入路123例,微骨孔入路加无框架立体定向手术64例。350例开颅手术中颅内占位病变158例,其中脑膜瘤引例,胶质瘤45例,垂体腺瘤12例（经蝶入路5例）,神经鞘瘤10例,颅咽管瘤6例,血管网织细胞瘤5例,转移瘤5例,其它24例;动脉瘤108例,动静脉畸形53例,海绵状血管瘤31例。脊髓手术14例。结果 病灶和重要解剖结构定位准确,病灶定位误差均在2mm以内,术后血肿和神经功能损害分别为1例和22例,占6.0％,无手术死亡。结论 微创手术对脑和脊髓外科,尤其对切除脑深部病灶很有帮助,可以准确发现病灶,保护正常神经组织,改变了传统神经外科手术模式。

Objective To evaluate the utility of minimally invasive neurosurgery. Methods We retrospectively reviewed 364 cases of craniotomy and laminectomy using minimally invasive neurosurgery. In these cases, 177 were operated with frameless stereotaxy, 123 by keyhole approach, 64 with combined frameless stereotaxy and keyhole approach. Three hundred and fifty craniotomies were performed for 158 cases of brain tumor including 51 meningiomas, 45 gliomas, 12 pituitary tumors ( transsphenoidal surgery in 5 cases), 10 neurinomas, 6 craniopharyngiomas, 5 angioreticulomas, 5 metastatic tumors, 24 other tumors; 108 aneurysms; 53 AVMs; 31 cavernous malformations, and 14 spinal surgeries. Results Lesions and important anatomical structures were accurately localized, and the computer - estimated errors were within 2 mm. Postoperative neurological complications occurred in 22 cases (6. 0% ) , and there was no death in this group. Conclusion Minimally invasive neurosurgery is valuable for patients with lesions in the deep brain, and its locating - accuracy is very important in protecting normal brain tissues. Neuronavigation system has changed the traditional neurosurgical procedures into the minimally invasive neurosurgery.