多模态导航联合术中磁共振在颅内病变穿刺活体组织检查中的应用  

Implementation of multimodal navigation combined with intraoperative magnetic resonance imaging in the frameless stereotactic biopsy of intracranial lesions

作　　者：张家墅[1] 陈晓雷[1] 王群[1] 侯远征[1] 孙国臣[1] 李昉晔[1] 余新光[1] 许百男[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华医学杂志》2017年第29期2288-2292,共5页National Medical Journal of China

基　　金：解放军总医院科技创新苗圃基金项目（15KMM19）;解放军总医院临床科研扶持基金（2016FC-TSYS-1023）

摘　　要：目的评估多模态导航联合术中磁共振（iMRI）在颅内病变穿刺活体组织检查手术中的应用价值。方法2009年2月至2016年12月共有156例患者在解放军总医院神经外科接受多模态导航联合术中磁共振辅助下活体组织检查手术。多模态中的代谢信息指导穿刺靶点的选择，功能和结构信息引导穿刺针避开重要结构，术中磁共振用于反馈穿刺部位的准确性及修正错误的穿刺靶点。记录活体组织检查阳性诊断率、术前后神经功能、手术过程参数及手术结果等指标。结果第1次术中扫描修正了7例（4.5%）错误的穿刺点，最后1次扫描证实穿刺靶点准确率为100%，术后病理学诊断阳性率为96.8%（151/156）。尽管术前86（55.1%）例病变紧邻功能区，但活体组织检查前后患者的神经功能评分差异无统计学意义。术中扫描发现6例（3.8%）穿刺部位血肿，均得到及时处理。结论多模态导航与术中磁共振辅助下颅内病变穿刺活体组织检查是一种安全、准确、有效的手术方式，对于提高手术的准确性，降低手术相关并发症有所帮助。ObjectiveTo investigate the impact and value of multimodal navigation and intraoperative magnetic resonance imaging （iMRI） on the biopsy of intracranial lesions. MethodsFrom February, 2009 to December, 2016, this study enrolled 156 patients, who underwent multimodal navigation and iMRI-guided brain biopsy in the Neurosurgery Department of PLA General Hospital. Metabolic information was used for biopsy target selection. Intraoperative guidance helped biopsy trajectory avoid the eloquent structures. iMRI was performed to prove the biopsy accuracy and to revise the incorrect biopsy. Diagnostic rate, perioperative neurological status, surgical parameter, and surgical outcome were recorded. ResultsThe first iMRI helped to revise 7 （4.5%） incorrect biopsy sites, and final iMRI confirmed biopsy accuracy in all cases. Postoperative diagnostic rate was 96.8% （151/156）. No statistical difference was found between postoperative and preoperative neurological statuses, despite 86 （55.1%） lesions were adjacent to eloquent areas. Additionally, iMRI detected 6 （3.8%） intraoperative hematomas that were treated immediately. ConclusionsBrian biopsy with iMRI and multimodal navigation is a safe, accurate and efficient biopsy modality. This technique may help increase the biopsy accuracy with low morbidity and mortality.

关 键 词：神经导航 磁共振成像 活体组织检查 颅内病变 

分 类 号：R651.1[医药卫生—外科学]