在术中MRI及神经导航辅助下手术切除第三脑室后部、松果体区肿瘤  

Microsurgery assisted by intraoperative MRI and neuronavigation for tumors in the posterior parts of the third cerebral ventricles and pineal regions

作　　者：张军[1] 许百男[1] 余新光[1] 陈晓雷[1] 姜金利[1] 余光宏[1] 孙国臣[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中国临床神经外科杂志》2010年第4期201-203,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨在术中MRI和功能神经导航引导下切除第三脑室后部及松果体区肿瘤的实用性和临床疗效。方法本组病人8例,男性5例,女性3例。全部病人均在术中MRI和显微镜功能神经导航系统辅助下行开颅肿瘤切除。术中行MRI扫描1～3次,平均2次。如术中扫描提示肿瘤残留,则经校正神经导航后再次切除残余肿瘤。结果全切除肿瘤6例,次全切除2例。2例术后出现梗阻性脑积水,后行第三脑室造瘘术好转。病理结果:星形细胞瘤3例、松果体细胞瘤2例、生殖细胞瘤1例、胶质母细胞瘤1例和神经节细胞胶质瘤1例。术后随访1～8个月,6例恢复良好,1例遗留部分视力、视野损害,1例出现一侧肢体轻瘫。结论术中MRI能够有效判断肿瘤的切除程度,功能神经导航可以判断肿瘤组织与周围重要功能结构的关系,最终做到最大程度切除肿瘤及最大限度的神经功能保留。Objective To explore the practicability of the resection of the tumor in the pineal region and posterior part of the thirdc erebral ventricle by the intraoperative MRI and neuronavigator-assisted microsurgery and its clinical effects.Methods Them icrosurgery assisted by intraoperative MRI and neuronavigation was performed in 8 patients with tumors in the third cerebral ventriclesa nd pineal regions,including 5 male and 3 female.The intraoperative MRI were averagely performed twice in each case.The residualt umors which were revealed by intraoperative MRI were further removed with the renewed neuronavigation system.Results Total ands ubtotal removal of the tumors were achieved respectively in 6 and 2 cases.The third ventriculostomy was performed because ofp ostoperative obstructive hydrocephalus in 2 patients..Pathological examination revealed that of 8 patients,3 suffered froma strocytomas,2 pineocytomas,1 germ cell tumor,1 glioblastoma and 1 ganglioglioma.The following-up from 1 months to 8 monthss howed that 6 patients had a good recovery,1 visual defect and 1 mild paresis.Conclusions The extent of tumor resection can bea ssessed effectively by intraoperative MRI.Functional neuronavigation is very helpful to estimating the relationship between intracraniall esions and critical neural structure.Therefore,Maximizing the resection of the lesion and minimizing the injury to neurological functionc an be achieved by intraoperative MRI and functional neuronavigation.

关 键 词：术中MRI 第三脑室 松果体 肿瘤 神经导航 手术 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]