胼周动脉瘤开颅夹闭术中磁共振神经导航的应用  

Application of magnetic resonance neuronavigation assistance in neurosurgical clipping of pericallosal aneurysms

作　　者：黄巍[1] 王文浩[1] 罗飞[1] 林洪[1] 张源[1] 张明升 李君[1] 简腾景 郑建仙 Huang Wei;Wang Wenhao;Luo Fei;Lin Hong;Zhang Yuan;Zhang Mingsheng;Li Jun;Jian Tengjing;Zheng Jianxian(Department of Neurosurgery, the 175 th Hospital of PLA, the Affiliated Southeast Hospital of Xiamen University, Fufian Province, Zhangzhou 363000, China)

机构地区：[1]解放军第一七五医院厦门大学附属东南医院神经外科,福建省漳州市363000

出　　处：《中国脑血管病杂志》2018年第6期281-286,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：福建省自然科学基金项目(2018J01152)

摘　　要：目的探讨磁共振神经导航辅助技术在胼周动脉瘤开颅夹闭术中的安全性及临床疗效。方法回顾性连续纳入2010年1月至2017年1月解放军第一七五医院神经外科行开颅夹闭术的胼周动脉瘤患者40例,术前分别经CT血管成像(CTA)、磁共振血管成像(MRA)或DSA检查确诊。根据术式的不同,将40例患者分为常规手术组(18例)和神经导航辅助组(22例)。神经导航辅助组在常规纵裂入路基础上辅以磁共振神经导航技术,准确定位动脉瘤及上引流静脉,设计切口及手术路径。比较两组手术时间、手术相关并发症(引流静脉损伤后脑水肿或脑梗死以及术区继发出血)及预后良好[改良Rankin量表(mRS)评分<3分]比例。结果 (1)40例患者均在显微镜下经纵裂入路行开颅胼周动脉瘤夹闭术,术后经CTA或DSA证实均为完全夹闭。神经导航辅助组手术时间短于常规手术组[(2.5±0.5)h比(3.5±0.4)h,t=1.254],静脉损伤后脑水肿或静脉性脑梗死比例少于常规手术组[4.5%(1/22)比6/18],组间差异均有统计学意义(均P<0.05);两组意外破裂和继发出血发生率的差异均无统计学意义(均P>0.05)。(2)两组患者均完成了术后6个月的随访,常规手术组预后良好者占12例,神经导航辅助组预后良好者20例(90.9%),两组预后良好比例的差异无统计学意义(χ2=3.545,P>0.05)。结论采用磁共振神经导航辅助技术有助于病灶的术中精确定位及优化手术入路,从而有效实施脑保护,降低手术风险,提高手术精度及安全性,是胼周动脉瘤开颅夹闭术的有效辅助手段。Objective To investigate the safety and clinical efficacy of magnetic resonance neuronavigation assisted technique in neurosurgical clipping of pericallosal aneurysms. Methods From January 2010 to January 2017,40 consecutive patients with pericallosal aneurysm treated with neurosurgical clipping at the Department of Neurosurgery,the 175 th Hospital of PLA were enrolled retrospectively. They were diagnosed by CT angiography（ CTA）,magnetic resonance angiography（ MRA） or digital subtraction angiography（ DSA） before operation. According to the different surgical methods,40 patients were divided into either a routine surgical group（ n = 18） or a neuronavigation assistance group（ n = 22）. On the basis of the conventional longitudinal fissure approach,the neuronavigation assistance group was treated with the magnetic resonance neuronavigation technique. The aneurysms and upper drainage vein,design incision and surgical approaches were accurately located. The operation time,surgical complications（ edema or infarction after drainage vein injury and secondary bleeding in the operated area） and proportion of good prognosis（ the modified Rankin scale[mRS]score 〈3） were compared. Results（ 1） Under the microscope,40 patients underwent clipping of pericallosal aneurysms via longitudinal fissure approach. Postoperative CTA or DSA confirmed that they were all completed clipped. The operation time of the neuronavigation assistance group were shorter than that of the routine surgical group（ 2. 5 ± 0. 5 h vs. 3. 5 ± 0. 4 h,t = 1. 254）,and the proportion of edema or venous infarction was less than that of the routine surgical group（ 4. 5% [1/22] vs.6/18）. The difference between the two groups was statistically significant（ all P〈0. 05）; there were no significant differences in the incidences of accidental rupture and secondary hemorrhage between the two groups（ all P〉0. 05）.（ 2） Both groups of patients completed the 6-month follow-up. There were 12 patients（ 12/18） with

关 键 词：颅内动脉瘤 神经导航 显微外科手术 大脑前动脉瘤 磁共振成像 

分 类 号：R651.1[医药卫生—外科学]