MRI与Dyna-CTA/3D-DSA影像融合在鞍旁跨颅中后窝肿瘤手术中的应用价值  

Application of MRI and Dyna-CTA/3D-DSA images fusion to surgery for the parasellar tumors extending into both the middle and posterior cranial fossae

作　　者：韦可[1] 姚国杰[1] 龚杰[1] 杜威[1] 李成才[1] 陈大瑜[1] 肖炳祥[1] 向伟楚[1] 马廉亭[1] 

机构地区：[1]广州军区武汉总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2015年第7期385-388,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨MRI与Dyna-CTA/3D-DSA影像融合在鞍旁跨中后颅窝肿瘤切除手术中的应用价值。方法 5例跨中后颅窝的鞍旁肿瘤,其中三叉神经鞘瘤2例,脑膜瘤2例,胆固醇样肉芽肿1例,术前行MRI与Dyna-CTA/3D-DSA三维影像融合,了解肿瘤与毗邻血管关系,其中2例将融合的数据通过Dicom格式输入神经导航系统,在神经导航及电生理监测下行肿瘤切除术。结果 5例患者手术均顺利完成,术后除1例外展神经麻痹未改善外余原有颅神经损害均恢复,且无并发症,MRI复查显示肿瘤完全切除。结论术前MRI与Dyna-CTA/3D-DSA三维融合影像,尤其是动态融合影像上,可在融合影像的冠状位、矢状位与轴位上从前到后、从左到右、从上到下了解肿瘤与毗邻血管关系,有助于减少手术对血管损伤,提高手术的全切率与安全性。Objective To explore the application of MRI and Dyna-CTA/3D-DSA images fusion to the surgery for the parasellar tumors extending into both the middle and posterior cranial fossae. Methods Of 5 cases of the parasellar tumors extending into both the middle and posterior eranial fossae, 2 were trigeminal schwannomas, 2 meningiomas and 1 cholesterol granuloma. MRI and Dyna-CTA/ 3D-DSA images fusion was performed before the operations in all the patients in order to understand the relationship of the tumors with the surrounding blood vessels. Of 5 patients, 3 underwent surgery trough subtemporal approach and 2 through extended pterional approach under electrophysiological monitoring. Results The tumors were totally resected in 5 patients, who were recovered well after the operation without the obvious complications except unrelief of the unilateral abduct nerve paralysis in 1 patient. Conclusions MRI and Dyna-CTA/3D-DSA images fusion before the operations, especially the dynamic image fusion, can figure out the relationship of the tumors with the surrounding blood vessels in the coronal, sagittal and axial views of fused images and therefore the operative damage to the blood vessels may be reduced and the operative safety may be enhanced.

关 键 词：鞍旁跨中后颅窝肿瘤 Dyna—CTA 3D—DSA MRI 三维影像融合 手术 

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