术中磁共振及神经导航系统在内镜经鼻蝶窦入路切除巨大垂体腺瘤中的应用

Implementation of intraoperative magnetic resonance imaging and neuronavigation system in endoscopic endonasal approach surgery of 66 giant pituitary adenomas

目的 评价术中磁共振和神经导航技术在66例经鼻内镜巨大垂体腺瘤手术中的应用.方法 2009年7月至2013年6月,共计66例由单个术者在术中磁共振导航下经鼻内镜行垂体腺瘤切除手术.肿瘤大小为40.0 ～ 59.9 mm,平均48.5 mm.根据术中扫描结果,决定继续切除或者结束手术.结果 66例手术共扫描103次,扫描1～3次,平均1.56次.第1次扫描发现残留30例,其中13例未进一步手术,17例进一步手术,再次扫描全切14例,3例没有全切,进一步手术后1例扫描全切.肿瘤全切除程度由54.5％增加到77.3％.2例术中扫描发现了必须处理的术区出血,均成功处理;未发生与术中磁共振相关的并发症或安全事故.结论 术中磁共振和神经影像导航技术不仅可以提高肿瘤的全切除率,而且能够在术中及时发现术区血肿并清除,但并不能将所有发现的残余肿瘤切除,术中发现不能进一步切除的肿瘤总是位于海绵窦及鞍上周边.

Objective To evaluate the clinical implementation of intraoperative magnetic resonance imaging （MRI） and neuronavigation system in the endoscopic endonasal approach surgery of giant pituitary adenomas.Methods From July 2009 to June 2013,66 patients with giant pituitary adenomas were operated with endoscopic endonasal approach by a single doctor.The tumor size range was 40.0-59.9 mm,mean 48.5mm.Based on the results of the scan of intraoperative MRI,the further resection was performed.Results 103 scans were performed in 66 cases from 1 to 3 times （mean 1.56 times per case） in each procedure.After the first scan,30 residual tumors were detected,and 17 undergone the further resection.After the second scan,3 residual tumors were revealed,and one was removed totally.The ratio of total removal tumor was increased to 77.3% from 54.5%.The hemorrhage of tumor field was found in 2 cases,and removed successfully.There was no intraoperative MRI related safety issue or accident recorded in this study.Conclusions The intraoperative MRI and neuronavigation system could not only increase the ratio of total removal tumor,but also detect the bleeding timely during the operation for further evacuation.However,not all the residual tumors could be removed totally,which always located in the cavernous sinus and superior and paraseller regions.