MRI与Dyna-CTA融合影像结合神经导航在经鼻蝶垂体腺瘤切除术中的应用

Application of MRI and CTA fusion images combined with neuronavigation to transsphenoidal microsurgery for pituitary adenomas

目的 探讨MRI与Dyna-CTA融合影像在垂体腺瘤尤其是侵袭性垂体腺瘤经鼻蝶切除术前评价、术中导航和手术切除过程中的应用价值。方法 13例垂体腺瘤患者术前均行MRI与Dyna-CTA影像融合,了解肿瘤与海绵窦段颈内动脉的关系,并将融合数据输入神经导航系统,在神经导航辅助下行经鼻蝶入路肿瘤切除术。结果 手术显微镜下肿瘤全切除7例,次全切除4例,大部分切除2例。手术并发症包括短暂性尿崩6例,术后垂体功能低下5例,术中脑脊液漏1例;无颈内动脉损伤,无死亡病例。术后随访3个月~1年,1例患者再次手术,1例行γ刀治疗。结论 术前MRI与Dyna-CTA三维动态融合影像,可全方位了解肿瘤与毗邻血管关系,有助于减少手术对血管损伤,提高手术的全切率与安全性。

Objective To explore the applied value of MRI and Dyna-CTA fusion images to the preoperative assessment, intraoperative neuronavigation and transsphenoid microsurgery for the pituitary adenomas, especially for invasive pituitary adenomas. Methods MRI and Dyna-CTA images fusion was performed before the operation in 13 patients with pituitary adenomas in order to understand the relationship of the adenornas with the surrounding blood vessels （internal carotid artery and cavernous sinus）. The integrated MRI and Dyna-CTA images fusion data were inputted into the neuronavigation system. The adenomas were resected by the neuronavigator-assisted transsphenoid mierosurgery in all the patients. Results Of 13 patients with pituitary adenomas, 7 received total resection of the tumors, 4 subtotal and 4 greatly part. The postoperative complications included transient diabetes insipidus in 6 patients, panbypopituitarism in 5, and cerebrospinal fluid rhinorrhea in 1. There were no carotid artery injury and perioperative death in all the patients. The follow-up duration ranged from 3 months to 1 year. Of 2 patients who received great part resection of the tumors, 1 was treated by gamma knife and 1 underwent surgery again. Conclusions MRI and Dyna-CTA images fusion before the operation, especially the dynamic image fusion, can figure out the relationship of the tumors with their surrounding blood vessels in the coronal, sagittal and axial views of fused images and therefore the operative damage to the blood vessels may be reduced and the operative safety may be enhanced.