摘要
目的探讨术前头部弥散张量成像(DTI)结合术中超声引导下导丝定位技术,在功能区深部脑肿瘤手术的应用价值。方法自2018年1月至2018年5月,给13例功能区深部脑肿瘤患者术前行头部DTI检查,根据DTI技术重建脑白质纤维三维图像,并与MRI图像整合,明确肿瘤与白质纤维束的三维空间结构关系。采用避开功能区皮层、尽量减少白质纤维束损伤的原则设计手术入路;并在术中超声引导下导丝定位肿瘤。术后72 h内复查头部MRI增强扫描评估肿瘤切除程度,术后4周采用KPS评分评估患者的身体功能状态。结果本组患者的肿瘤定位均准确,10例患者的肿瘤完全切除,3例患者因术中冰冻病理检查为淋巴瘤,仅取活检。术后病理检查示,胶质瘤6例,转移瘤4例,淋巴瘤3例。术后患者均未出现新的神经功能缺失症状,8例患者的神经功能缺失症状较术前改善,5例患者的症状同术前。结论对功能区深部脑肿瘤采用术前头部DTI结合术中超声引导下导丝定位技术,能精准定位肿瘤,并能够实时指引手术路径;在最大限度地切除肿瘤的同时,又可有效保护神经功能;是一种简单、安全、有效的辅助手术方法,值得临床推广应用。
Objective To evaluate the value of preoperative head diffusion tensor imaging(DTI)combined with ultrasound guided silk guidance in the operation of deep seated brain tumors in functional areas.Method 13 patients with deep brain tumor in functional areas were selected and underwent head DTI examination before surgery from January 2018 to May 2018.According to this,the surgical approach was formulated and the intraoperative ultrasound-guided guidewire was used to locate the tumor,so as to evaluate the tumor removal rate and the degree of nerve function preservation.Results Of 13 patients,there were 6 cases of glioma,4 of metastasis and 3 of lymphoma.The tumor location of 13 patients was accurate,the tumor was completely removed in 10 patients,and the frozen pathology in 3 patients reported lymphoma,so only biopsy was taken.None of the postoperative patients showed any new symptoms of neurological deficit,8 patients showed improved symptoms of neurological deficit before surgery,and 5 patients showed the same symptoms before surgery.Conclusions For patients with deep brain tumors in functional areas,the preoperative head DTI combined with intraoperative ultrasound guided silk guidance technology is used to accurately locate the tumor,and can guide the surgical path in real time to effectively protect the nerve function while removing the tumor to the maximum extent.It is a simple,safe and effective method,which deserves clinical attention and promotion.
作者
李国夫
张磊
程莹莹
程文
张学新
王宁
LI Guo-fu;ZHANG Lei;CHENG Ying-ying(Department of Neurosurgery,Harbin Medical University Cancer Hospital,Harbin 150081,China)
出处
《临床神经外科杂志》
CAS
2018年第6期436-439,443,共5页
Journal of Clinical Neurosurgery
基金
黑龙江省卫生计生委科研项目(2018-371)
哈尔滨医科大学附属肿瘤医院海燕基金青年项目(JJQN2018-15)
关键词
脑功能区
脑肿瘤
弥散张量成像
术中超声
导丝定位
brain eloquent brain regions
brain tumor
dispersion tensor imaging
intraoperative ultrasound
wire localization
