术中磁共振成像在经鼻-蝶入路垂体瘤切除术中的应用研究

目的 探讨术中磁共振成像结合神经影像导航系统在经鼻-蝶人路垂体肿瘤切除术中的应用价值.方法 采用术中MRI扫描辅助神经导航系统指导经鼻-蝶入路垂体肿瘤切除范围,分析术中MRI对手术过程和患者预后的影响.结果 术中MRI扫描系统平均扫描（2.11土0.41）次,所需时间15~20 min/次;手术时间共延长47~60 min,平均（51.20±0.66） min.38例患者术中MRI共发现11例存在肿瘤残余,其中8例于更新神经导航计划后进一步扩大手术范围全切除肿瘤,3例因肿瘤质地坚韧且与周围解剖结构粘连紧密,仅行部分切除;初次全切除率为71.05%（27/38）,在术中MRI导航系统辅助下最终全...

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Published in中国现代神经疾病杂志 Vol. 12; no. 2; pp. 203 - 208
Main Author 贺中正 苏少波 张川 韩志铁 李勇刚 岳树源
Format Journal Article
LanguageChinese
Published 天津医科大学总医院神经外科,300052 2012
Subjects
垂体肿瘤
监测,手术中
磁共振成像
立体定位技术
磁共振成像
监测,手术中
立体定位技术
垂体肿瘤
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Summary:目的 探讨术中磁共振成像结合神经影像导航系统在经鼻-蝶人路垂体肿瘤切除术中的应用价值.方法 采用术中MRI扫描辅助神经导航系统指导经鼻-蝶入路垂体肿瘤切除范围,分析术中MRI对手术过程和患者预后的影响.结果 术中MRI扫描系统平均扫描（2.11土0.41）次,所需时间15~20 min/次;手术时间共延长47~60 min,平均（51.20±0.66） min.38例患者术中MRI共发现11例存在肿瘤残余,其中8例于更新神经导航计划后进一步扩大手术范围全切除肿瘤,3例因肿瘤质地坚韧且与周围解剖结构粘连紧密,仅行部分切除;初次全切除率为71.05%（27/38）,在术中MRI导航系统辅助下最终全切除率达92.10%（35/38）,提高了21.05%（8/38;X2=4.290,P=0.018）.术后无一例发生与磁共振检查相关性并发症.结论 经鼻-蝶入路垂体肿瘤切除术中应用MRI结合神经导航技术,为指导手术进程及实时判断手术效果提供了客观依据,从而避免了因术中脑组织漂移造成的术前导航偏差,提高肿瘤全切除率.
Bibliography:Objective To discuss the application of the intraoperative magnetic resonance imaging （iMRI）-based neuronavigation system in transnasal-sphenoidal surgery for pituitary adenoma. Methods Thirty- eight pituitary adenomas were resected via nasal- sphenoidal approach with assistance of the American GE Signa 1.5T intraoperative magnetic resonance system associating German Brain LAB neuronavigation system. The clinical materials, iMRI quality and its influence on the surgical process and results were analyzed. Results Intraoperative scanning was performed 2 or 3 times in each patient, averaging （2.11 ＋ 0.41）times. The scanning time was 3-5 min, and adding the packaging and transporting process, the whole procedure required 15-20 min. Posing the position, fixing the head rest and navigation registering took 32-40 rain in all. So the total operation may last 47-60 min, averaging （51.20 ＋ 0.66） min. The iMRI was used to scan and collect pictures. Residual tumor tissue was revealed in 11 cases. Eight of the 11 cases un
ISSN:1672-6731
DOI:10.3969/j.issn.1672-6731.2012.02.022