多种技术辅助经颅神经内镜下切除颅内病变

Transcranial neuroendoscopic resection assisted with multiple techniques for intracranial lesions

目的探讨多种技术辅助经颅神经内镜下切除颅内病变的手术策略和效果。方法回顾性分析22例经颅神经内镜下切除颅内病变病人的临床资料,术前均行头颅CT薄层扫描、头颅MRI平扫+增强。术中联合应用神经电生理、术中超声、术中神经导航、超声吸引(ultrasonic aspiration,CUSA)、锁孔技术和内镜固定臂,在完全神经内镜下切除病变。结果病灶全切除21例,近全切除1例。术后发生颅内感染1例,肺部感染1例,均经治疗后痊愈出院。随访1~19个月,无复发及死亡病例,除1例术前偏瘫者,其余病人Karnofsky评分均在90分以上。术后病理诊断:脑膜瘤14例,胶质瘤4例,转移瘤1例,胆脂瘤1例,动静脉畸形1例,脑脓肿1例。结论气动固定臂配合经颅神经内镜下,联合神经导航、术中超声等多种技术,能够精准定位颅内病灶,做到功能保护下最大化切除病灶。

Objective To explore the surgical strategy and treatment effect of transcranial neuroendoscopic resection assisted with multiple techniques for intracranial lesions.Methods Clinical data of 22 patients with intracranial lesions undergoing transcranial neuroendoscopic resection were analyzed retrospectively.CT thin slice scan and MRI examination were performed before the operation in all the patients.Multiple techniques including neuroelectrophysiological monitoring,Doppler ultrasound,neuronavigation,ultrasonic aspiration(CUSA),keyhole and endoscopy holder were combined application during the operation.Results Total focus resection was achieved in 21 patients and subtotal resection in 1.Intracranial infection occurred in 1 patient and pneumonia in 1,who was cured after the treatment.During a follow-up period of 1 to 19 months,no patient died or recurred.Karnofsky scores weremore than 90 in all the patients except for 1 patient with hemiplegia before the operation.The pathological diagnosis showed 14 meningiomas,4 gliomas,1 metastasis,1 cholesteatoma,1 arteriovenous malformation and 1 brain abscess.Conclusion Transcranial neuroendoscopy combined with air-driven arm and multiple techniques such as navigation,intraoperative ultrasound and so on,can accurately locate the intracranial lesion and achieve the maximal resection of the lesions under functional protection.