MSCTA在大型脑膜瘤个性化手术方案设计中的应用价值  

Application of MSCTA in designing the personalized surgical plan for large meningioma

作　　者：陈建强[1] 关莹[2] 李刚[3] 陈晶[1] 金虎[3] 李小华[2] 韩向君[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院放射科,海口570208 [2]海南医学院附属医院影像教研室,570102 [3]中南大学湘雅医学院附属海口医院神经外科,海口570208

出　　处：《放射学实践》2013年第9期942-946,共5页Radiologic Practice

基　　金：海南省自然科学基金(808246)

摘　　要：目的:探讨多排螺旋CT血管成像(MSCTA)在设计大型脑膜瘤个性化手术方案中的应用价值。方法:对146例直径>5cm的脑膜瘤患者术前行MSCTA检查,利用三维重建图像模拟手术操作设计个性化手术方案,包括手术入路、手术术式、全切方案及术前栓塞治疗与否,以术中所见为标准评价手术方案合理性。结果:通过MSCTA模拟操作后146例患者均合理设计了个性化手术方案,其中MSCTA显示19例颅内重要动脉明显阻碍手术操作窗而改变了常规入路途径,50例瘤体模拟单纯入路由于基底较宽或入路远侧瘤体暴露困难而改为联合扩大术式,35例瘤体侵及视神经、脑干走行区或包裹颅内重要动脉提示全切风险大而术前早期制定了次全切手术方案及放疗计划,14例窦旁脑膜瘤因窦腔闭塞而制定瘤体及静脉窦全切方案,42例富血供瘤体行术前颈外动脉栓塞治疗。术中所见与模拟操作所遇情况高度一致,瘤体暴露充分、合理,有效避免了颅内重要血管、神经功能区及静脉窦的损伤,降低了并发症的发生率,瘤体切除范围理想。结论:通过MSCTA模拟手术操作可充分、准确了解术中情况,评估手术方案的合理性和风险度,协助临床医生术前制定最佳治疗方案。Objective:To study the value of multi-slice spiral CT angiography(MSCTA)in designing the personalized surgical plan for large meningioma.Methods:146 patients with meningioma(diameter greater than 5cm)were examined with MSCTA preoperatively.All patients were designed the personalized surgical plan preoperatively according to the MSCTA,including surgical approach,surgical procedures,total cut and preoperative embolization or not,then evaluate the rationality of operation scheme by the intraoperative findings.Results:MSCTA showed impediment of operative window by important intracranical artery in 19 cases,and chages of conventional approach was decided.The surgical planning was changed due to wide base of tumor or if was difficult to expose the distal part of tumor in 50 cases.MSCTA showed invasion of optic nerve or brain stem so there was high risk for total resection in 35 cases,and subtotal resection and radiotherapy was planned.In 14 cases of invasion of cerebral sinus,a total resection of the tumor and cerebral sinus was planned.In 42 cases of rich vascular supplying of the tumor,apreoperative embolization of external carotic artery was performed.The intraoperative findings were highly consistant with simulation images.There was adequate exposure of the tumor during the operation,the injury of important nerve and vessels and sinus were avoided.The degree of tumor resection was ideal.There was significant reduction of postoperative complication.Conclusion:MSCTA simulation of surgical procedures can provide better understanding of intraoperative condition,correct evaluation of rationality and risk of surgical plan,and then development of an optional treatment options.

关 键 词：脑膜瘤 血管造影术 数字减影 体层摄影术 X线计算机 

分 类 号：R739.4[医药卫生—肿瘤] R814.42[医药卫生—临床医学]