高场强术中磁共振成像系统在内镜脊索瘤手术中的初步应用  

Implementation and preliminary experience of high-field intraoperative magnetic resonance imaging in the endoscopic chordoma operation with transsphenoidal or transoral approach

作　　者：周涛[1] 孟祥辉[1] 许百男[1] 魏少波[1] 陈晓雷[1] 周定标[1] 侯远征[1] 肖炳祥[1] 余光宏[1] 王东[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华外科杂志》2011年第8期699-702,共4页Chinese Journal of Surgery

摘　　要：目的总结高场强术中磁共振成像（iMRI）系统在内镜经口或经鼻脊索瘤手术中应用的初步经验。方法自2009年1月至2010年12月，共有23例脊索瘤患者进行了内镜经口或鼻iMRI辅助下的手术。男性12例，女性11例，年龄29～64岁，平均（424-3）岁。肿瘤最大径2．0～5．7cm，平均（3．5±0．8）cm。术中应用1．5T移动磁体双室设计的iMRI系统，其中20例联合使用了神经导航系统。结果23例内镜经口或鼻脊索瘤手术中，扫描次数1～5次，平均2．5次，20例应用了导航技术，12例根据术中扫描更新了导航的资料。15例iMRI扫描发现了肿瘤残留。其中12例进一步手术切除，并最终经iMRI扫描证实9例得到全切除，3例残留肿瘤得到进一步切除。肿瘤全切除率由34．8％（8／23）提高到73．9％（17／23）。在15例术中扫描发现肿瘤残留的脊索瘤中，巨大脊索瘤占9例。巨大脊索瘤术中扫描残留检出率为9／11，其他脊索瘤术中扫描残留检出率为6／12。未发生与iMRI相关的并发症或安全事故。结论高场强iMRI系统能够在术中获得高质量的影像，为手术中实时判断肿瘤切除程度提供了客观依据，提高了内镜经口或鼻脊索瘤的肿瘤切除程度和手术安全性。Objective To review the preliminary clinical experience with high-field-strength intraoperative magnetic resonance imaging （iMRI） in the endoscopic chordoma operation with transsphenoidal or transoral approach. Methods From Janury 2009 to December 2010, 23 patients [ range, 29-64 years,mean age （42 ± 3 ） years ] of chordoma were operated with endoscopic transsphenoidal or transoral approach and examined intraoperatively with a movable 1.5 T iMRI magnet. Tumor size range was 2. 0-5.7 cm, mean （3.5 ±0. 8）cm. A navigation system based on iMRI was used in 20 cases. Results iMRI scan were performed in each operation from 1 time to 5 times. Neuronavigation system were used in 20 operations and the data renewed in 12 cases by the information from iMRI. In 15 of 23 patients, iMRI had revealed residual lesions and resulted in 12 cases further treatment, eventually, 9 tumors were totally removed and 3 tumors were further removed. The ratio of total removal tumor was enhanced to 73.9% （17/23）from 34. 8% （8/23）. Among 15 cases of paitial chordoma removal detected by scanning in operation, 9 were huge chordoma. The residual of huge ehordoma detected by scanning in operation was 9/11, and other chordoma contributed to 6/12. There were no iMRI related safety issue or accident recorded in this study. Conclusions High-field-strength iMRI provids high-quality images of tumor resection that allows intraoperative modification of the surgical strategy. Combined with the navigation system, iMRI is helpful to maximize the resection of the chordoma and benefit for the safety of endoscopic operation.

关 键 词：脊索瘤 磁共振成像 神经导航 经蝶手术 神经内镜 

分 类 号：R739.4[医药卫生—肿瘤]