低频段小探头B超在神经外科手术中的应用

Clinical application of intra-operative low frequency and small probe ultrasound to neurosurgery

目的：探讨低频段小探头B超（LFSPU；频率范围3-9 MHz）在神经外科手术中的应用价值。方法收集2014年1月至2014年12月利用LFSPU辅助颅脑手术的病例98例，其中脑肿瘤68例，脑脓肿12例，婴幼儿脑积水分流手术10例，脑内血肿8例。结果婴幼儿前囟或3 cm×2 cm骨窗即可满足LFSPU探头置放和探测需求，探测距离在7 cm以上，探测到最小病灶直径为1.0 cm，最深5.5 cm。LFSPU均显示所有病灶、脑室端分流管和脓肿穿刺针，定位成功率为100%；肿瘤病灶切除后，术中LFSPU发现残留肿瘤23例，继续切除16例（病理学证实为肿瘤13例），7例因残留病灶位于重要区域未进一步切除。结论术中LFSPU可通过小骨窗和未闭前囟进行探测，实时动态监测手术过程，在神经外科手术中有重要的临床价值。

Objective To explore the value of intraoperative low frequency and small probe ultrasound （LFSPU） to the neurosurgical operation. Methods The clinical data of 98 patients who underwent neurosurgery and received intraoperative LFSPU examination from January, 2014 to December, 2014, were analyzed retrospectively. Of these 98 patients, 68 suffered from intracranial tumors, 12 from cerebral abscess, 10 from brephyhydrocephalus and 8 from intracranial hematomas. Results The bregmas in the infants with hydrocephalus and 2 cm×3 cm bone window were enough for use of LFSPU, which could detect the range of more than 7 cm, and the smallest lesion of 1.0 cm in diameter. All the lesions, shunt tubes in the cerebral ventricles, probe for the cerebral abscess could be clearly seen by LFSPU. The successful rate of positioning the lesions was 100%. After the resections of the tumors, intra-operative LFSPU showed that there were tumorous residues in 23 patients, of whom, 16 further underwent the resection of the residues and 7 not because the residues were in the important cerebral regions. Conclusion LFSPU can be implemented via the small bone window or unclosed bregma in the infants during the neurosurgery for the intracranial lesions and provide real time information through dynamic monitoring for the operation. LFSPU is of important value for the neurosurgical operation.