多模态影像导航融合技术在神经内镜经蝶垂体腺瘤切除术中的应用体会  

Application of multimodal navigation and image fusion technology in neuroendoscopic surgery of pituitary adenomas via transsphenoidal approach

作　　者：韩鹏[1] 李旭琴[1] 于军[1] 金点石[1] 罗可[1] 冷晓磊[1] 胡英杰[1] 

机构地区：[1]大连医科大学附属大连市中心医院神经外科,116000

出　　处：《中国微侵袭神经外科杂志》2017年第7期322-325,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨多模态导航影像融合技术在内镜经蝶垂体腺瘤手术中的应用价值。方法回顾性分析47例垂体腺瘤病人的临床资料,均行导航辅助下内镜经蝶入路手术。术前行鞍区薄层CT扫描、颅脑MRA融合40例,行鞍区薄层CT扫描、头部CTA融合7例。结果均通过导航准确定位病变,肿瘤全切除38例,次全切除9例。术后脑脊液漏3例,感染1例,一过性尿崩症10例;无手术死亡和术后出血病例。随访3~24个月,多数病人术前症状不同程度好转;全切除病例中复发3例,行γ-刀治疗;次全切除病例中复发1例,予以再次手术。结论神经导航影像融合技术可以提供病变及周边组织结构三维图像,结合神经内镜良好照明和视野,可增加肿瘤全切率,减小垂体功能损伤,缩短手术时间,减少并发症。Objective To explore the application values of multimodal navigation and image fusion technology in neuroendoscopic surgery of pituitary adenomas via transsphenoidal approach. Methods Clinical data of 47 patients with pituitary adenomas were analyzed retrospectively, and endoscopic surgery assisted with navigation via transsphenoidal approach was performed in all the patients. Before the operation, the thin-section CT scans of the sellar region were performed in all the patients, and brain MRA fusion in 40 patients and brain CTA fusion in 7. Results The lesions were accurately positioned by navigation in all the patients. Total tumor resection was achieved in 38 patients and subtotal resection in 9. Cerebrospinal fluid leakage occurred in 3 patients, infection in 1 and transient diabetes insipidus in 1 after the operation. No patient died and no bleeding occurred. During a follow-up period of 3 to 24 months, the preoperative symptoms were improved to different extents in most patients. Recurrence occurred in 3 patients of total resection and 1 in subtotal resection, andγ-knife treatment and resurgery were carried out respectively. Conclusions Neuronavigation and image fusion technique can provide three-dimensional structural images for the lesions and surrounding tissues. Combined with the good illumination and visual field of neuroendoscopy, it can increase the rate of total tumor resection, reduce pituitary dysfunction, shorten the operation time and reduce the complication.

关 键 词：垂体肿瘤 神经导航 神经内镜 多模态影像融合 

分 类 号：R736.4[医药卫生—肿瘤]