术中磁共振成像在儿童后颅窝占位性病变手术中的应用  

Application of intraoperative magnetic resonance imaging in the operation of children with posterior cranial fossa space-occupying lesions

作　　者：张超 丁兴华[1,2,3,4] 张荣 Zhang Chao;Ding Xinghua;Zhang Rong(Department of Neurosurgery,Huashan Hospital,Shanghai Medical College,Fudan University,Shanghai 200040,China;National Center for Neurological Disorders,Shanghai 200040,China;Neurosurgical Institute of Fudan University,Shanghai 200040,China;Shanghai Clinical Medical Center of Neurosurgery,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]国家神经疾病医学中心,上海200040 [3]复旦大学神经外科研究所,上海200040 [4]上海市神经外科临床医学中心,上海200040

出　　处：《中华神经外科杂志》2022年第7期653-657,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨术中磁共振成像(iMRI)在儿童后颅窝占位性病变切除术中应用的可行性、安全性及其对病变全切除率的影响。方法回顾性分析2019年3月至2021年3月复旦大学附属华山医院神经外科采用iMRI辅助后颅窝占位切除术治疗的27例患儿的临床资料,观察iMRI相关耗时、病变全切除率、不良事件及术后并发症的发生情况。将iMRI显示病变无残留定义为全切除;残留病变体积≤20%为大部切除。结果27例患儿均安全完成手术及iMRI检查。27例患儿单次iMRI的相关总耗时为(58.5±11.6)min(43~87 min)。27例患儿首次iMRI结果显示,24例(88.9%)为病变全切除,3例(11.1%)为大部切除;其中2例进一步切除病变,第2次iMRI显示病变均全切除。应用iMRI后病变全切除率提高至96.3%(26/27)。术中3例患儿发生麻醉相关不良事件,iMRI扫描过程中无不良事件发生。术后无一例发生颅内感染;仅1例(3.7%)发生切口感染、愈合不良。结论在儿童后颅窝占位性病变切除术中应用iMRI具有可行性,可提高病变全切除率,且不增加手术的相关风险和并发症。Objective To investigate the feasibility and safety of intraoperative magnetic resonance imaging(iMRI)in the resection of children′s space-occupying lesions in the posterior cranial fossa and its effect on the total resection rate of the lesions.Methods The clinical data of 27 children who underwent iMRI-assisted resection of space-occupying lesions in the posterior fossa in the Department of Neurosurgery,Huashan Hospital,Shanghai Medical College,Fudan University from March 2019 to March 2021 were retrospectively analyzed.We documented the information including iMRI-related time-consuming,total lesion resection rate,adverse events and postoperative complications.Total resection was defined as no residual lesion on iMRI;subtotal resection was defined as residual lesion volume of≤20%on iMRI.Results All 27 patients underwent the operation and iMRI safely.The relevant total time for a single iMRI of the 27 children was 58.5±11.6 min(43-87 min).The first iMRI results of the 27 children showed that 24(88.9%)had total resection of the lesions;three(11.1%)had subtotal resection;two of them underwent further resection,and the second iMRI showed that both lesions were completely resected.The total resection rate of lesions increased to 96.3%(26/27)after applying iMRI.Anesthesia-related adverse events occurred in 3 children during the operation,and no adverse events occurred during the iMRI scan.No intracranial infection occurred after operation;only 1 case(3.7%)had incision infection and poor healing.Conclusion It is feasible to apply iMRI in the resection of space-occupying lesions in the posterior cranial fossa in children,which can improve the total resection rate of the lesions without increasing the associated risks and complications of surgery.

关 键 词：磁共振成像 颅窝 后 神经外科手术 儿童 肿瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]