神经导航联合超声切除伴发癫痫的脑胶质瘤

Neuronavigation combined with intraoperative ultrasound in the resection of gliomas with epilepsy

目的探讨神经导航联合术中超声在切除伴发癫痫的脑胶质瘤中的临床应用。方法回顾性分析2012年6月30日—2014年6月30日期间在河北省人民医院神经外科行神经导航联合术中超声辅助下手术治疗的47例伴发癫痫的脑胶质瘤患者临床资料,对比分析手术前后胶质瘤切除程度及癫痫的控制情况。结果依照神经导航设计范围切除肿瘤后,行术中超声检查,发现18例有残余肿瘤,需再次切除。经术后病理验证,再次切除的部分均存在肿瘤细胞。术后47例患者无血肿、感染、偏瘫。术后48 h复查核磁共振(MRI)显示肿瘤全切除34例,大部切除13例。术后1年评估癫痫控制情况,Engel'sⅠ级17例,Engel'sⅡ级20例,Engel'sⅢ级10例。在保护神经功能的同时切除肿瘤、控制癫痫发作,临床效果显著。结论神经导航有助于术前定位病灶和脑功能区以及设计手术入路,术中指引病灶和功能区的位置和边界;术中超声具有无创、可重复、实时检查等诸多优势,实现最大程度切除胶质瘤及致痫灶,降低患者术后神经功能障碍的发生率。

Objective To investigate the clinical value of neuronavigation combined with intraoperative ultrasound in the resection of glioma with epilepsy. Methods To review and analyze the clinical data of 47 glioma patients with epilepsy treated by intraoperative ultrasound-assisted neuronavigation during the period from June 30, 2012 to June 30, 2014, and to compare and analyze the extent of gliom resection and the control of epilepsy before and after surgery. Results All the patients had no hematoma, infection or hemiplegia. MRI was reviewed 48 hours after surgery and MRI showed complete resection in 34 cases and subtotal resection in 13 cases. One year after the operation, the seizure control was evaluated. Engel’s class I, 17 cases, Engel’s class II, 20 cases, Engel’s class III, 10 cases. When the nerve function is protected, the tumor is removed and the epileptic seizure is controlled, and the clinical effect is remarkable. Conclusions Neuronavigation is helpful to locate the lesion and brain functional area and design the surgical approach before surgery, and to guide the location and boundary of the lesion and functional area during surgery.Intraoperative ultrasound has many advantages such as noninvasive, repeatable and real-time examination.Neuronavigation combined with intraoperative ultrasound can achieve maximum resection of gliomas and epileptogenic foci and reduce the incidence of postoperative neurological dysfunction in patients.