应用神经导航系统对成人幕上胶质瘤手术切除的临床研究

The clinical study of surgical removal of supratentorial gliomas by using neuonavigation system

目的 应用神经导航系统对成人幕上胶质瘤实施手术 ,研究肿瘤全切除与神经功能保护。方法 85例病人 ,病变位于大脑半球各部位 ,为不同病理类型的胶质瘤。肿瘤直径从 1 8cm到7 0cm ,平均 5 5cm。手术全过程在导航系统引导与监视下进行。结果 肿瘤全切 76例 ,近全切 5例 ,大部切除 4例。所有肿瘤全切病人术后增强颅MRI或CT检查未发现肿瘤残留病灶。手术后有 49例病人出现明显的神经功能障碍 ,表现为不同程度的肢体瘫痪和 (或 )语言障碍 ,不全偏盲 ,但全部病例在 2个月内恢复 ,无一例病人留有永久性神经功能障碍。所有 8例术前偏瘫的病人在术后短期内症状得到明显改善 ,均下地行走 ,KPS从术前的 6 0～ 70分增加到 80～ 90分。结论 应用神经导航系统可对大多数大脑半球不同部位胶质瘤病人做到影像学意义肿瘤全切除 ,并且不引起病人术后永久性神经功能障碍。

Objective To study how to totally remove the supratentorial gliomas and protec of neuro-function by using neuro-navigation system. Methods 85 patients with supratentorial gliomas were operated by using neuro-navigation surgiscope in the Neurosurgical Department of Beijing Tiantan Hospital between Dec.1997 and Jun.2000. Of these patients, 34 were female and 51 were male, with an average age of 38.3 years (ranging from 17 to 60). Among them, 33 were diagnosed as astrocytomas, 5 were mixed gliomas, 18 were anaplastic astrocytoms, 22 were glioblastomas, 5 were oligodendrogliomas and 2 were anaplastic oligodendrogliomas. The diameters of tumors were from 1.8cm to 7cm,with a mean size at 5.5cm. The gliomas grew at any locations of cerebral hemispheres. In 85 patients, 25 cases at frontal lobes, 11 at frontoparietal lobes,19 at frontotemporal lobes, 13 at temporal lobes and 17 at other lobes. The operations were guided by neuro-navigation system. Results Of these 85 cases, 76 were totally removed, 5 were subtotally removed and 4 were partial removed. All patients whose tumor had been totally removed had no residual tumor on their postoperative enhancement MRI or CT scaning. 45 patients suffered from hemiparesis and/or speech difficulty instantly after operation but completely recovered within 2 months. 8 patients with preoperative hemiparesis were improved after operation.Conclusions With the help of Neuro-navigation Surgiscope, many gliomas located in the cerebral hemispheres can be totally removed without permanent neurofunction damages, thus realiaing mini-invasive operation.