神经导航辅助胶质瘤手术

Neuronavigator-guided glioma surgery

目的 评价神经导航系统在胶质瘤手术中的应用。方法 在 80例胶质瘤手术中 ,应用StealthStation神经导航系统指导手术操作。在其中 2 7例手术中测量硬膜、皮质以及病灶移位程度。在大脑浅表胶质瘤手术中 ,使用微导管栅栏法纠正脑移位的影响 ,判断肿瘤边界。结果 80例平均座标误差为 (2 .0 3± 0 .89)mm ,10cm预期准确性 (2 .4 3± 0 .99)mm。术中硬膜、皮质以及病灶移位分别为 (3.4 4± 2 .39)mm、(7.5 8± 3.75 )mm以及 (6 .5 5± 3.19)mm。 5例虽然导航显示肿瘤残留 ,但未强行切除 ;其余 75例肿瘤全切 6 2例 (82 .7% ) ,次全或大部切除 13例 (17.3% )。术后症状改善或不变 6 8例 (85 .0 % ) ,术后症状加重或出现新症状 12例 (15 .0 % ) ,无死亡病例。结论 在胶质瘤手术中 ,术中脑移位是影响神经导航准确性的重要因素。微导管栅栏法简便、实用 ,有助于提高肿瘤切除率 。

Objective To evaluate the effectiveness of neuronavigator guided surgery for the resection of gliomas.Methods 80 patients with gliomas underwent surgical treatment, with the guidance of StealthStation neuronavigator to estimate the extent of tumor resection. In 27 cases, the measurement of the shifts of the dura, cortical surface, and lesion margin was recorded during the operation. The technique of 'micro catheter fence posts'' was used in cerebral hemisphere gliomas to compensate the brain shift.Results Mean fiducial error and predicted accuracy in 10 cm were (2.03±0.89) mm, (2.43±0.99) mm, respectively. The shifts of the dura, cortical surface, and lesion margin were (3.44±2.39) mm?(7.58±3.75) mm, and (6.55±3.19) mm, respectively. Although neuronavigation showed the residual tumor, operations discontinued due to the deep location of the tumor in 5 cases. In other 75 cases, total tumor removal was achieved in 62(82.7%), subtotal removal in 13 (17.3%). Postoperatively, neurological symptoms were improved or unchanged in 68 cases (85.0%), worsen in 12 cases(15.0%), no dead case. Conclusion Intraoperative brain shift plays an important role in the loss of spatial accuracy in neuronavigator guided glioma surgery. The technique, 'micro catheter fence posts' for glioma surgery, was quite useful for brain shift and total tumor removal, contributing to the increase of the total tumor removal and decrease of the surgical complications.