多模态神经导航影像融合辅助神经内镜在垂体腺瘤经鼻蝶入路手术的应用  

Application of multimodal neuronavigation image fusion assisted neuroendoscopy in transnasal transsphenoidal surgery for pituitary adenoma

作　　者：黄鑫[1] 周健[1] 陈少军[1] 姜莱[1] 彭磊 Huang Xin;Zhou Jian;Chen Shaojun;Jiang Lai;Peng Lei(Department of Neurosurgery,The People's Hospital of China Three Gorges University,Yichang,Hubei 443000,China)

机构地区：[1]三峡大学人民医院神经外科,宜昌443000

出　　处：《中国微侵袭神经外科杂志》2020年第6期256-259,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨多模态神经导航影像融合技术辅助神经内镜在垂体腺瘤经鼻蝶入路手术的临床应用。方法回顾性分析102例垂体腺瘤病例资料,均采用多模态神经导航影像融合技术辅助神经内镜经鼻蝶入路治疗。病人术前均行薄层头颅MRI增强、头部CTA检查,利用MRI、CTA图像、三维CT制定导航计划,引导手术。结果术后肿瘤全切除80例(78.43%),次全切除22例(21.57%)。术后视力视野改善率83.33%(50/60),激素治愈率46.15%(36/78)。术后发生脑脊液鼻漏6例(5.88%),一过性尿崩26例(25.49%),电解质紊乱81例(79.41%),颅内感染2例(1.96%),鞍区血肿4例(3.9%),经对症处理后病人均康复并出院。结论多模态神经导航影像融合辅助神经内镜下经鼻蝶入路垂体腺瘤切除术安全、有效,有助于术者精确定位,方便手术操作,术野显露清晰,可获得满意疗效。Objective To explore the clinical application of multimodal neuronavigation image fusion technology assisted neuroendoscopy in transnasal transsphenoidal surgery for pituitary adenoma.Methods The clinical data of 102 patients with pituitary adenoma were analyzed retrospectively.Multi-modality neuronavigation image fusion technology was used to assist neuroendoscopic transnasal transsphenoidal surgery.Before operation,patients underwent thin-layer head MRI enhancement and head CTA examination,and the navigation plans was made using MRI,CTA images and three-dimensional CT to guide the operation.Results Total tumor resection was achieved in 80 cases(78.43%)and subtotal resection in 22(21.57%).The postoperative visual field improvement rate was 83.33%(50/60),and the hormone cure rate was 46.15%(36/78).Postoperative cerebrospinal fluid rhinorrhea occurred in 6 cases(5.88%),transient diabetes insipidus in 26(25.49%),electrolyte disturbance in 81(79.41%),intracranial infection in 2(1.96%),sellar region hematoma in 4(3.9%).After symptomatic treatment,the patients recovered and were discharged.Conclusions Multimodal neuronavigation image fusion technology assisted neuroendoscopy for pituitary adenoma surgery via transnasal transsphenoidal approach,is safe,effective,and helpful for accurate positioning,convenient operation,adequate exposure of the operative field,thus can obtain satisfactory therapeutic efficacy.

关 键 词：垂体肿瘤 神经内镜 神经导航 多模态 入路 经鼻蝶 

分 类 号：R739.41[医药卫生—肿瘤] R736.4[医药卫生—临床医学]