无框架脑立体定向手术在微创神经外科中的应用价值

Clinical evaluation of frameless stereotaxy in minimally invasive neurosurgery

目的探讨无框架脑立体定向手术在微创神经外科的应用价值。方法1999年11月至2001年6月进行无框架脑立体定向手术200例,其中颅内动静脉畸形43例,动脉瘤39例,脑膜瘤30例,海绵状血管瘤27例,胶质瘤19例,神经鞘瘤8例,垂体腺瘤5例,血管网织细胞瘤4例,转移癌3例,其他14例;脊髓肿瘤8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,术后神经功能损害10例,占5.0%,无手术死亡。结论无框架脑立体定位手术对脑和脊髓手术,尤其是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,是微创神经外科的保障。

Objective To evaluate the utility of frameless stereotaxy in minimally invasive neurjosurgery.Method The patients had a MRI or CT and the information of the MRI or CT was analyzed in the neuronavigation systems before operations.Here3-D simulation of design of operative approach must be done.During the operations,the accurate location of the lesions could be obtained.A retrospective review of200cases of the craniotomy and the laminotomy procedures using frameless stereotaxy systems,from December1999to June2001,was made,including43AVMs,39aneurysms,30meningiomas,27cavenous malfomations,19gliomas,8neuronomas,5pitutary tumors,4angioreticulomas,3matastatic tumors,14others and8spinal tumors.Re sult The lesions and important anatomy structues were accurately located and the computer estimated errors were within2mm.The postoperative neurological complications occurred in10cases(5.0%).No operative death.Conclusion The frameless stereotaxy is valvuable and very helpful for brain and spinal surgery,expecially the cases with lesions locating in the deep center of the brain.In addition,its accuracy of location is very important for protecting normal brain tissues.The neuronavigation systems are changing the way in which surgeons perform the traditional neurosurgical procedures and ensure the minimally invasive neurosurgery.