运动功能区占位病变的立体定向显微切除术

Stereotactic microsurgery for the masses located in motor area

目的探讨采用微侵袭手术方法切除运动功能区病灶的可能性。方法在立体定向引导与显微镜结合下对17例位于运动功能区病灶进行了切除手术,观察手术后效果。结果16例病灶得以全切,1例次全切。12例术前有癫者中9例完全消失,2例减轻,1例无效。6例术前有功能障碍者中,3例恢复正常,2例较术前症状明显减轻,1例症状有所加重。11例术前没有功能障碍者中,仅有1例遗留对侧拇指的灵活性减退。结论运用立体定向与显微镜相结合的微侵袭手术方法切除大部分运动功能区病灶是安全的。

Objective To study an effective method to resect the lesion located in motor area with stereotactic minimally invasive operation. Methods 17 patients age 7-73, whose lesions in 9-25 mm diameters located in motor area were selected to operate with ZCE-M multifunctional stereotactic instrument and microscope. Preoperative symptoms of these patients included epilepsy, hemiparesis and intracranial hypertension. Enhanced CT scan was used to localization, and local anesthesia was used in 11 patients, general anesthesia in 6 patients. The width of cortex incision was within 10-25 mm, and entered through sulcus of brain which was the closest to lesion. Results Total resection of lesions were performed in 16 patients, and subtotal resection was in one patient. Follow-up was lasted 8-47 months. Nine of 12 patients who suffered from epilepsy before operation were cured, other two were controlled well by drugs, and only one was not controlled well. Three patients who had normal limb function presented disturbance after operation, but two of them recovered within 2 months, another one suffered from powerlessness of the thumb. Three of 6 patients who had limb disturbance before operation were cured, other two were obviously improved, and only one got worse. Pathological results: infective lesions in 10 patients, metastasis tumor in 2 patients, angiocavernoma in 2 patients, and glioma in 2 patients, AVM in 1 patient. Conclusion It is safe and effective to use Minimally invasive technology combine stereotactic instrument with microscope to resect the small lesions located in motor area.