Zhang Yan, Lin Song, Zhao Ji-zong, Zhao Yuan-li, Wang Shuo, Jiang Zhong-li, Zhang Mao-zhi, Wang Ke-da
Department of Neurosurgery, Capital Medical University, Beijing, China.
Zhonghua Wai Ke Za Zhi. 2011 Aug 1;49(8):716-9.
To analyze the reliability and clinical value of intraoperative ultrasound combined with neuronavigation for resection of intracranial cavernous malformations.
From January 2007 to December 2009, 40 cases of intracranial cavernous malformations were operated under the application of intraoperative ultrasound combined with neuronavigation. There were 18 male and 22 female, aged 18 to 58 years, with a mean age of 34.5 years. Neuronavigation was used for all patients before operation to display the three-dimensional model of nervous system and lesions, so to design the operative approach and determine the scope of the incision. Lesions were allocated by real-time neuronavigation in order to continuously verify the accuracy of operative approach during the operation, supplemented by real-time monitoring of intraoperative ultrasound to guide the process of surgery and determine the extent of resection of lesions.
The registration error of neuronavigation was 1.3 - 3.2 mm, with an average of 2.0 mm. All the patients' three-dimensional model of nervous system and lesions were satisfactorily displayed, and the area of lesions were all accurately located. Structural brain-shifts occurred in 4 cases in the remove process of the lesion, with shift degree 5.0 - 10.0 mm, and were corrected by intraoperative ultrasound. All lesions were well displayed by intraoperative ultrasound. Gross total resection was achieved in all patients, with no patient infected or dead. Neurological deterioration was seen in 2 patients, the morbidity was 5.0%.
The combination of neuronavigation and intraoperative ultrasound for resection of intracranial cavernous malformations can provide valuable intraoperative informations of the location and resection level of the lesion, thereby maximize the accuracy of lesion localization and the extent of resection, with less complications and enhanced efficacy of the surgery.
分析术中超声联合神经导航在颅内海绵状血管瘤切除术中的可靠性及临床价值。
2007年1月至2009年12月，应用术中超声联合神经导航对40例颅内海绵状血管瘤患者进行手术。其中男18例，女22例，年龄18～58岁，平均年龄34.5岁。所有患者术前均采用神经导航显示神经系统及病变的三维模型，以设计手术入路并确定切口范围。术中通过实时神经导航对病变进行定位，以不断验证手术入路的准确性，同时辅以术中超声实时监测，指导手术进程并确定病变切除范围。
神经导航的注册误差为1.3～3.2mm，平均2.0mm。所有患者的神经系统及病变三维模型显示满意，病变区域均准确定位。4例患者在病变切除过程中出现脑结构移位，移位程度为5.0～10.0mm，经术中超声校正。术中超声均清晰显示所有病变。所有患者均实现了肿瘤全切除，无感染及死亡病例。2例患者出现神经功能恶化，发生率为5.0%。
神经导航与术中超声联合应用于颅内海绵状血管瘤切除术，可为术中提供病变位置及切除程度的重要信息，从而最大限度提高病变定位的准确性及切除范围，减少并发症，提高手术疗效。
