高场强术中磁共振神经导航辅助经鼻蝶窦入路切除垂体腺瘤

High-field intraoperative magnetic resonance imaging-based neuronavigation system assisted transnasal-sphenoidal approach for resection of pituitary adenomas

目的探讨高场强术中磁共振（iMRI）神经导航系统对经鼻蝶窦入路垂体腺瘤切除手术的辅助作用。方法回顾性分析天津医科大学总医院神经外科2011年4月至2014年4月应用高场强iMRI神经导航系统辅助经鼻蝶窦入路手术切除335例垂体腺瘤，总结其手术效果和应用经验。结果185例患者在iMRI检查中共发现58例存在肿瘤残余，其中40例患者在更新神经导航计划后进一步行手术全切除肿瘤。初次全切除率为68．7％（127／185），在iMRI导航系统辅助下最终全切除率达90．3％（167／185），提高了21．6％（40／185）。高场强iMRI扫描1—3次，所需时间15—20min／次；手术时间共延长了30～60min，平均（41．30±5．62）min。结论经鼻蝶窦入路垂体肿瘤切除术中应用高场强iMRI结合神经导航技术，为指导手术进程及实时判断手术效果提供了客观依据，提高了手术安全性和肿瘤全切除率。

Objective To investigate the assistant effects of high-field intraoperative magnetic resonance imaging （iMRI）-based neuronavigation system in transnasal-sphenoidal approach for resection of pituitary adenomas. Methods The pituitary adenomas of 335 patients resected via high-field iMRI-based neuronavigation system assisted transnasal-sphenoidal approach at the Department of Neurosurgery, Tianjin Medical University General Hospital from April 2011 to April 2014 were analyzed retrospectively. The operative effect and application experiences were analyzed. Results Of the 185 patients, 58 had residual tumor tissue in the iMRI detection, 40 of them underwent further surgical resection of tumor after updating neuronavigation plan. The initial total resection rate was 68. 7% （127/185）. Under the assistance of iMRI navigation system, the final total resection rate reached 90. 3% （ 167/185）, increasing by 21.6% （40/ 185）. High-field iMRI scan was performed for 1 to 3 times. The time required was 15-20 min/time. The total operative time prolonged 30 to 60 rain （mean, 41.30 ± 5.62 min）. Conclusious In transnasal-sphenoidal approach for resection of pituitary adenomas, using high-field iMRI in combination with neuronavigation technology may provide objective evidence for the guidance of surgical process and real-time judgment of surgical results, and improve the surgical safety and total resection rate of tumors.