神经导航多模态系统辅助神经内镜在KnospⅢ、Ⅳ级垂体腺瘤手术中的应用  

Neuronavigation multimodal system assisted neuroendoscopy in Knosp Ⅲ, Ⅳ pituitary adenoma surgery

作　　者：陈炼 赵君爽 孙广烨 周锦鹏[1] 李龙[1] 景治涛[1] CHEN Lian;ZHAO Jun-shuang;SUN Guang-ye(Department of Neurosurgery,the First Affiliated Hospital of China Medical University,Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院神经外科,沈阳110001

出　　处：《临床神经外科杂志》2019年第2期119-122,128,共5页Journal of Clinical Neurosurgery

基　　金：辽宁省自然科学基金(20170541022)

摘　　要：目的探讨神经内镜联合神经导航多模态系统在侵袭性垂体腺瘤切除术中的应用,及其效果。方法回顾性分析中国医科大学附属第一医院神经外科2014年1月—2018年1月,手术治疗的104例侵袭性垂体腺瘤患者的临床资料。其中,70例患者在神经导航多模态系统的辅助下行肿瘤切除术(神经导航组),34例患者在没有术中影像引导下行传统手术(对照组)。比较两组患者侵袭性垂体腺瘤手术切除的程度、术后并发症的发生情况和复发率。结果对照组中20例患者(58. 8%)的肿瘤完全切除,神经导航组中有59例患者(84. 3%)完全切除;两组肿瘤全切率比较,差异有统计学意义(P <0. 05)。术后,神经导航组中有10例患者(14. 3%)出现并发症,其中尿崩症4例、脑脊液鼻漏4例、视力下降2例。对照组中18例患者(52. 9%)出现并发症,其中术后出血1例、尿崩症6例、视力下降5例、脑脊液鼻漏6例。对照组的术后并发症发生率明显高于神经导航组,差异有统计学意义(P <0. 05)。对照组中5例次全切除或部分切除的患者在术后12个月内肿瘤复发。结论神经导航多模态系统可以在手术过程中,实时呈现病变及其与邻近神经血管之间的空间关系,能显著提高侵袭性垂体腺瘤的全切率,减少并发症发生率和肿瘤复发率。神经导航多模态系统和神经内镜的结合成为侵袭性垂体腺瘤术中引导的重要工具。Objective To investigate the application of neuroendoscopy combined with neuronavigation in invasive pituitary adenoma resection. Methods The clinical data of 104 patients with invasive pituitary adenomas treated by neurosurgery in the First Affiliated Hospital of China Medical University from January 2014 to January 2018,were analyzed retrospectively.Of 104 patients,70 of invasive pituitary adenoma resection (neuronavigation group) were performed with the aid of neuronavigation multimodal system and 34 were performed with traditional surgery without intraoperative imaging guidance (control group).The degree of surgical resection of invasive pituitary adenoma,the incidence of postoperative complications and the recurrence rate were compared between the two groups. Results In the control group,20 cases (58.8%) were completely resected.In the neuronavigation group,59 cases (84.3%) underwent complete resection.There was significant difference between the two groups in tumor resection ( P <0.05). Postoperative complications observed in 10 patients (14.3%) in the neuronavigation group showed diabetes insipidus was in 4 cases,cerebrospinal fluid rhinorrhea in 4 and vision loss in 2.In contrast,18 cases (52.9%) had postoperative complications,including 1 of postoperative hemorrhage,6 of diabetes insipidus,5 of visual acuity loss and 6 of cerebrospinal fluid rhinorrhea.The incidence of postoperative complications in the control group was significantly higher than that in the neuronavigation group.There was significant difference in the incidence of complications between the two groups ( P <0.05).During follow-up,5 patients in the control group who underwent subtotal or partial resection recurred within 12 months. Conclusions The multimodal neuronavigation system can present the lesion and its spatial relationship with adjacent nerve vessels in real time during the operation.It can significantly increase the total removal rate of invasive pituitary adenoma and reduce the incidence of complications and recurrence.The combi

关 键 词：侵袭性垂体腺瘤 神经导航多模态系统 神经内镜 三维重建 

分 类 号：R651[医药卫生—外科学]