移动磁体双室高场强术中磁共振成像系统在经蝶窦垂体腺瘤手术中的初步应用  

Dual room high - field intraoperative magnetic resonance imaging suite with a movable magnet： implementation and preliminary experience in pituitary adenoma operation through transsphenoidal approach

作　　者：盂祥辉[1] 许百男[1] 魏少波[1] 陈晓雷[1] 佟怀宇[1] 余新光[1] 周定标[1] 侯远征[1] 肖炳祥[1] 余光宏[1] 王东[2] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853 [2]中国人民解放军总医院磁共振室,北京100853

出　　处：《中华神经外科杂志》2010年第4期310-313,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：解放军总医院科技创新基金（ZY14）

摘　　要：目的总结移动磁体双窒高场强术中磁共振成像（iMRI）系统在经蝶窦垂体腺瘤手术中的初步经验。方法共有28例垂体腺瘤患者行经蝶窦人路iMRI辅助下的手术。肿瘤大小1．60～7．27cm，平均（3．37±0．65）cm。应用1．5T移动磁体双室设计的iMRI，其中14例联合使用神经导航系统，16例联合使用神经内镜。结果27例经鼻蝶窦手术，1例经口鼻蝶窦手术。28例经蝶窦垂体腺瘤手术中，13例iMRI发现肿瘤残留，其中3例巨大垂体腺瘤患者，由于肿瘤侵犯海绵窦包绕颈内动脉，虽经iMRI证实海绵窦内有肿瘤残留，但未勉强进一步切除。其余10例经iMRI证实垂体腺瘤均完全切除。未发生与iMRI相关的并发症或安全事故。结论移动磁体双室高场强iMRI系统能够在术中获得高质量的影像，为术中实时判断垂体腺瘤切除程度提供了客观依据，提高了垂体腺瘤的全切率。Objective To review the preliminary clinical experience with dual room intraoperative high -field -strength magnetic resonance （MR） imaging suite with a movable magnet in pituitary adenomas operation through transsphenoidal approach. Methods From February to July 2009, 28 patients （mean age： 46. 60 ± 8. 65 years old ） , of pituitary adenoma were operated through transsphenoidal approach and examined intraoperatively with a movable 1.5T MR magnet. The mean tumor size was 3. 37 ±0. 65 cm （ranged from 1.60 to 7. 27 cm）. A navigation microscope in combination with a ceiling - mounted navigation system enabled microscope - based neuronavigation in 14 cases. Neuroendoscope was also used in 16 eases. Results 27 operations through transnaso -sphenoidal approach were performed. Transoro - sphenoidal approach was performed in one patient. In 13 of 28 patients, intraoperative MR imaging had revealed residual lesions and resulted in the change of the surgical strategy. Further resection of tumors was not performed in three cavernous sinus invasion eases because of ICA encasement. The further total resection was achieved in the other 10 cases. There was no intraoperative MR related safety issue or accident in this study. Conclusions Dual room intraoperative high -field -strength magnetic resonance （MR） imaging suite with a movable magnet could provid high - quality intraoperative MR images and valuable information of tumor resection which arc helpful for intraoperative modification of the surgical strategy. It could be very helpful to maximize the resection of pituitary adenomas and minimize the injury to neurologieal function.

关 键 词：术中磁共振成像 垂体腺瘤 显微外科手术 神经导航 内镜 

分 类 号：R736.4[医药卫生—肿瘤]