术中镜下多模态神经导航在听神经瘤手术中的应用

Application of intraoperative multimodal neuronavigation under microscope in acoustic neuroma operation

目的探讨显微镜下多模态神经导航在听神经瘤手术中的应用价值。方法应用多模态神经导航切除听神经瘤51例(观察组),经传统枕下乙状窦后入路切除听神经瘤46例(对照组)。回顾性分析并比较两组手术相关资料。结果观察组镜下导航均获得成功,术中无明显移位现象,可持续性强。病例注册误差为(1.28±0.32)mm,示踪注册耗时(42.0±5.0)s;肿瘤、乙状窦及横窦体表投影准确,与开颅后观察一致。观察组手术时间短于对照组[(185±35)min vs.(225±42)min](P<0.05),肿瘤全切率和面神经保留也高于对照组(78.43%vs.58.70%和72.55%vs.52.17%)(P<0.05)。结论采用显微镜下多模态神经导航技术能有效提高听神经瘤手术全切率和面神经保留率,缩短手术时间。

Objective To explore the value of multimodal navigation under microscope in the surgery for acoustic neurilemoma.Methods Data of patients with acoustic neuroma underwent surgery were retrospectively analyzed,of whom 51 cases（group A）received multimodal navigation under microscope and 46 cases（group B）were operated upon by traditional surgery via suboccipital retrosigmoid approach.Results The multimodal navigation under microscope was successful and sustainable without shift phenomenon.Registration error was（1.28±0.32）mm and tracer registration spent for（42.0±5.0）s.The tumor,sigmoid sinus and transverse sinus surface projection were accurate and consistent with the observation after craniotomy.The surgeries in group A were all successfully performed under navigation with total tumor resection rate of 78.43% and facial nerve preservation rate of 72.55%,which were higher than 58.70% and 52.17% in group B（P〈0.05）.The time for operation was less in group A than that in group B[（185±35）min vs.（225±42）min]（P〈0.05）.Conclusion The multimodal navigation under microscope for acoustic neuroma can effectively improve the total removal rate and the preservation rate of facial nerve function,and shorten operation time.