神经导航结合管状脑牵开器技术在侧脑室三角区脑膜瘤手术中的应用及疗效分析  

Application and effect of neuronavigation-assisted tubular retractor system in surgery for trigone ventricular meningiomas

作　　者：张国滨[1] 任晓辉[1] 崔勇[1] 王永刚[1] 隋大立[1] 姜中利[1] 林松[1] Zhang Guobin;Ren Xiaohui;Cui Yong;Wang Yonggang;Sui Dali;Jiang Zhongli;Lin Song(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中华神经外科杂志》2020年第12期1231-1235,共5页Chinese Journal of Neurosurgery

基　　金：北京市优秀人才培养资助青年骨干个人项目(2018000021469G230);首都医科大学科研培育基金(PYZ19113)。

摘　　要：目的探讨神经导航结合管状脑牵开器技术在侧脑室脑膜瘤中的应用效果。方法回顾性分析2012年1月至2019年12月首都医科大学附属北京天坛医院神经外科行手术治疗114例侧脑室三角区脑膜瘤患者的临床资料。其中21例采用神经导航结合管状脑牵开器技术(简称管状脑牵开器组);93例采用传统的超声辅助下脑板牵开技术(简称脑板牵开组)。对比分析两组患者在手术创伤、术后并发症、术后影像学改变、住院时间、肿瘤复发率、总体生存率方面的差异。结果管状脑牵开器组和脑板牵开组的肿瘤全切率均达到100.0%,无围术期死亡患者。与脑板牵开组比较,管状脑牵开器组能减小骨瓣面积(中位数分别为39.9 cm^2、49.0 cm^2)、缩短皮质切开的长度(中位数分别为2.9 cm、3.7 cm)和住院时间(中位数分别为11.1 d、15.7 d)(均P<0.001);术后弥散加权成像提示管状脑牵开器组发生术野周围的脑缺血改变情况显著减少[分别为19.0%(4/21)、43.0%(40/93),P=0.042],同时术后并发症的发生率(包括视野缺损、失语、孤立颞角综合征)有减低的趋势,但差异无统计学意义[分别为9.5%(2/21)、28.0%(26/93),P=0.076]。114例患者中,有效随访98例(86.0%),98例患者的中位随访时间为16个月(1~94个月),随访期内脑板牵开组有4例肿瘤复发并再次行手术治疗;随访患者的总体生存率为100.0%。结论神经导航结合管状脑牵开器技术能够精准定位脑深部病变,有效减少手术创伤及术后并发症。Objective To investigate the application value of the neuronavigation-assisted tubular retractor system in surgical treatment of trigone ventricular meningiomas.Methods A total of 114 patients with trigone ventricular meningiomas who underwent surgical treatment from January 2012 to December 2019 at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University were retrospectively analyzed.Neuronavigation-assisted tubular retractor system(referred to as tubular retractor group)was employed in 21 cases and ultrasound-assisted traditional flat-blade retractor(referred to as traditional flat-blade retractor group)in 93 cases.The surgical trauma,postoperative complications,postoperative MRI changes,hospital stay length,recurrence rate and overall survival rate were compared between two groups.Results The tumor total resection rate in both groups reached 100%,and no patients died during the perioperative period.Compared with the traditional flat-blade retractor group,the tubular retractor group had smaller size of the bone flap(39.9 cm2vs.49.0 cm2,respectively),shorter cortical incision(2.9 cm vs.3.7 cm,respectively)and shorter length of hospital stay(11.1 d vs.15.7 d,respectively)(all P<0.001).Postoperative diffusion-weighted imaging(DWI)showed that cerebral ischemia around the operation field in the tubular retractor group was significantly reduced[19.0%(4/21)vs.43.0%(40/93)respectively,P=0.042].At the same time,the incidence of postoperative complications(including hemianopia,aphasia and trapped temporal horn syndrome)in the tubular retractor group tended to decrease,while the difference was not statistically significant[9.5%(2/21)vs.28.0%(26/93),P=0.076].Among 114 patients,98 patients(85.9%)were followed up successfully.The median follow-up time of 98 patients was 16 months(1-94 months).During the follow-up period,4 patients in the traditional flat-blade retractor group had tumor recurrence and underwent reoperation.The overall survival rate in both groups was 100%.Conclusion Neuronavigation-assis

关 键 词：脑膜瘤 侧脑室 神经导航 管状牵开器 脑板牵开器 

分 类 号：R739.45[医药卫生—肿瘤]