电磁神经导航辅助下脑膜瘤微创切除术  

Electromagnetic neuronavigation-guided minimally invasive meningioma surgery

作　　者：陈怀宾 张健[2] 衡雪源[2] 费昶[2] 程彦昊[2] 戴超[2] 宋启民[2] 

机构地区：[1]潍坊医学院临床学院神经外科教研室,山东潍坊261053 [2]临沂市人民医院神经外科,山东临沂276003

出　　处：《国际神经病学神经外科学杂志》2014年第3期198-200,共3页Journal of International Neurology and Neurosurgery

基　　金：山东省科技发展计划(2012YD18022)

摘　　要：目的探讨电磁神经导航技术在脑膜瘤微创手术中的应用。方法回顾性分析我院2010年1月至2013年6月在电磁导航辅助下手术治疗的37例脑膜瘤病例。凸面或窦镰旁脑膜瘤直径≤2.5 cm者13例,导航下标记肿瘤在体表的投影,采用直形切口,骨瓣直径4-5cm。凸面或窦镰旁脑膜瘤直径〉2.5 cm或/及较长硬膜尾征者21例,采用马蹄型切口,骨瓣直径5~8 cm。脑室内脑膜瘤3例,根据肿瘤与周边脑功能区的毗邻关系选择手术入路。结果37例患者图像注册到成功标记肿瘤用时9~22分钟,平均12±4.7分钟;图像注册误差0.62~2.0 mn,平均：1.44±0.4mm。simpson I级切除29例,8例窦镰旁脑膜瘤行slmpsonⅡ级切除。结论电磁神经导航引导下的脑膜瘤微创手术具有用时少、定位精确、切口小、创伤小、病变全切率高及并发症少等优点。Objective To investigate the application of electromagnetic neuronavigation in minimally invasive meningioma surgery. Methods A retrospective study was performed among 37 patients with meningiomas who received image-guided surgery with the assis- tance of Compass Cygnus PFS electromagnetic neuronavigation in our department between January 2010 and June 2013. Thirteen of all patients were diagnosed with convexity, parasagittal, or falcine meningiomas with tumor diameters equal to or less than 2.5 cm. Straight incision （dia. 5- 7 cm） was performed according to the projection of neoplasms on the body surface, with the assistance of electromagnetic neuronavigation, leaving bone flaps only 4 -5 cm in diameter. Twenty-one cases were diagnosed with convexity, pa- rasagittal, or falcine meningiomas with tumor diameters exceeding 2.5 cm and/or with longer dura tail signs, who received curved or horseshoe incision according to the projection of tumor or the margins of dura tail signs on the scalp, leaving bone flaps 5 - 8 cm in diameter. Among three cases of intraventricular meningiomas, the operative route was decided according to the relationship between neo- plasms and surrounding functional areas. Results Of all 37 patients, it took 9 to 22 minutes （ average 12 ~ 4.7 minutes） from image registration to labeling of tumor location. Error of image registration was between 0.62 to 2.0 mm （ average I. 44 - 0.4 mm）. Twenty- nine patients received Simpson grade I resection, and 8 patients with parasagittal meningiomas received Simpson grade II resection. All patients recovered uneventfully, except for one patient who developed intraventricular hemorrhage and fully recovered after being treated by external ventricular drainage. Conclusions Minimally invasive meningioma surgery aided by electromagnetic neuronavigation has many merits including short operative time, accurate localization, small skin incision, minimal surgical trauma, high rate of total resection, and few complications.

关 键 词：电磁神经导航 脑膜瘤 微创 

分 类 号：R739.45[医药卫生—肿瘤]