微型探头血管超声在颅底病变手术中的应用  

Application of microprobe vascular Doppler in the operation of skull base lesions

作　　者：莫志晓 张强[1] 马海峰[1] 陈罡[2] 惠品晶[2] 吴江[2] 袁帅 翟伟伟[2] 虞正权[2] Mo Zhixiao;Zhang Qiang;Ma Haifeng;Chen Gang;Hui Pinjing;Wu Jiang;Yuan Shuai;Zhai Weiwei;Yu Zhengquan(Department of Neurosurgery,Qinghai Provincial People′s Hospital,Xining 810007,China;Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]青海省人民医院神经外科,西宁810007 [2]苏州大学附属第一医院神经外科,215006

出　　处：《中华神经外科杂志》2019年第11期1148-1151,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨微型探头血管超声(MVD)在颅底病变手术切除中的应用效果。方法回顾性分析2017年9月到2018年9月苏州大学附属第一人民医院神经外科收治的13例颅底病变患者的临床资料。13例颅底病变包括:鞍区脑膜瘤6例,岩斜区脑膜瘤2例,KnospⅢ~Ⅳ级垂体腺瘤3例,鞍底斜坡区脊索瘤1例,眶内、颅底及蝶、筛窦曲霉菌感染后肉芽组织侵袭性生长1例。手术方法分别采用显微镜下开颅切除术(9例)和神经内镜经鼻入路切除术(4例),手术过程中均辅助应用MVD监测。术后行头颅CT和(或)MRI及激素水平随访。结果13例患者中,6例鞍区脑膜瘤及2例岩斜区脑膜瘤全切除6例、次全切除2例;3例KnospⅢ~Ⅳ级垂体腺瘤全切除2例、次全切除1例;1例鞍底斜坡区脊索瘤和1例眶内、颅底及蝶、筛窦曲霉菌感染后肉芽组织侵袭性生长的病灶均全切除。除曲霉菌感染患者术后视力未恢复外,其余患者术后症状均有所改善。1例术前血催乳素水平>204.0 ng/ml的催乳素腺瘤患者,术后经口服溴隐亭并行放疗后,末次复查血催乳素水平为11.3 ng/ml。垂体腺瘤患者术后均无垂体功能低下者。其中6例患者术后出现不同程度的电解质紊乱,4例患者术后发热,经治疗后出院前均恢复正常。所有患者随访(16.1±3.3)个月(10~22个月),影像学检查无病变复发的患者。结论颅底占位性病变和侵袭性病灶在手术切除过程中辅助应用MVD,可实时监测术区被病灶侵袭、包绕、推挤移位的重要血管,避免术中及术后出现不良后果,大大降低了手术风险。Objective To investigate the effect of microprobe vascular Doppler(MVD)on the operation of skull base lesions.Methods From September 2017 to September 2018,13 patients with skull base lesions at Neurosurgery Department of the first Affiliated Hospital of Soochow University were retrospectively analyzed.The 13 cases included 6 cases of meningioma in Sellar region,2 cases of meningioma in petroclival region,3 cases of pituitary adenoma of KnospⅢ-Ⅳgrade,1 case of chordoma in Sellar clival region,and 1 case of invasive growth of granulation tissue in intraorbital,skull base,sphenoid and ethmoid sinus after Aspergillus infection.The surgical methods included neuroendoscopic transnasal approach and microsurgical resection under craniotomy microscope.MVD was applied in all operations of this series.Medical imaging examination and follow-up were performed after operation.Results Among the 13 patients,total resection of meningioma in Sellar region was performed in 6 cases and subtotal resection in 2,total resection of Knosp gradeⅢ-Ⅳpituitary adenoma was conducted in 2 and subtotal resection in 1.Total resection was performed in 1 case of invasive growth of granulation tissue in intraorbital,skull base,sphenoid and ethmoid sinus after Aspergillus infection and 1 case of chordoma in Sellar base clival region.Uncorrected left eye vision was reported in the patient with Aspergillus infection post surgery.Postoperative symptoms of the other patients were improved.The prolactin level of 1 patient with prolactin adenoma was more than 204 ng/ml before operation.At 2 months post operation,the prolactin level was 105.66 ng/ml after oral bromocriptine combined with radiotherapy.The last reexamination was 11.3 ng/ml without hypophysis dysfunction.Six patients had varying degrees of electrolyte disorder after operation.Four patients had fever after operation and all returned to normal before discharge from hospital after treatment.All patients were followed up for(16.1±3.3)months(10-22 months),and there was no recurrence in i

关 键 词：颅底肿瘤 显微外科手术 自然腔道内镜手术 微型探头血管超声 

分 类 号：R[医药卫生]