多模态神经导航联合电生理技术在颅底肿瘤手术中的临床价值

The Clinical Value of Multimodal Neural Navigation Technology Combined with Electrophysiological Technique for the Surgery of Skull Base Tumors

目的:探讨多模态神经导航联合电生理技术在颅底肿瘤手术中的临床应用价值。方法:对26例颅底肿瘤患者进行术前MRI、CT及MRA等影像多模态融合,三维重建病灶,术中实时导航进行手术切除;其中17例在颅底附近贴附6个MARK,分别于开骨瓣前及切除病灶后检查是否发生移位,评估术中实时导航的精确性,并对后组颅神经进行全程电生理监测,保护相关颅神经。结果:多模态神经导航对肿瘤组织及其周围结构定位精确;在结合电生理监测下,手术全切除19例(73.1%),次全切除4例(15.4%),大部分切除3例(11.5%);对全部病例进行术后随访6~32个月,远期生活质量行为状态(KPS)评分80~100分,其中3例复发。结论:多模态神经导航融合可为术者提供全面的影像学信息,对术前合理设计手术切口和入路及预判大脑功能结构提供指导,增加手术的安全性;结合电生理技术能够最大化地切除病变肿瘤组织,并降低术后神经功能障碍的发生率,具有较高的临床应用价值。

Objective： To investigate the clinical value of multimodal neural navigation technology combined with electrophysiological techniques for the surgery of skull base tumors. Methods： Twenty-six patients with skull base tumors were performed preoperative multimodal image fusion of MR/, CT and MRA examination, three-dimensional reconstruction of the lesion, real-time navigation intraoperative surgical resection. Seventeen cases of the patients were attached 6 MARKs in the vicinity of the skull base. Whether the shift occurred was checked before the opening flap and after the resection of lesions. The cranial nerve electrophysiological was monitored in the entire process to protect the relevant cranial nerves. Results： Multimodal neural navigation technology combined with electrophysiological monitoring was effective and accurate in positioning tumor tissue and surrounding structures. 19 patients（73.1%） received total resection, 4 cases （15.4%） with subtotal resection, and 3 cases （11.5%） with most resection. All the patients have beeen followed up for 6 to 32 months and the Kar- nofsky Performance Status （KPS） score of long-term quality of life was 80 to 100 points, including three cases of recurrence. Conclusion： Multimodal neural navigation technology can provide general imaging information, help guide the preoperative surgical incision and rational design, approachs for brain function structure.