术中超声联合神经导航应用于低级别胶质瘤显微手术
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摘要
目的探讨术中超声(IOUS)联合神经导航在低级别胶质瘤(LGG)显微手术中的应用价值。方法对34例LGG在IOUS联合神经导航辅助下行显微切除手术,术后72 h内复查MRI,评价肿瘤切除程度,观察术后是否出现脑挫伤、脑出血等IOUS相关不良事件及颅内感染、脑血肿等并发症。结果 34例LGG,IOUS联合神经导航肿瘤发现率100%(34/34),定位肿瘤准确率100%(34/34)。术后72 h内MRI示肿瘤影像学全切除27例(27/34,79.41%),次全切除3例(3/34,8.82%),大部分切除4例(4/34,11.76%)。术后出现颅内感染2例,经抗感染治疗后好转;无IOUS相关不良事件发生。结论 IOUS联合神经导航可精确定位LGG,在最大程度上实现安全切除肿瘤。
Objective To explore the application value of intraoperative ultrasound(IOUS) combined with neuronavigation in the microsurgery of low-grade glioma(LGG). Methods Totally 34 patients with LGG underwent microsurgery assisted by IOUS combined with neuronavigation. The degree of tumor resection was evaluated by MRI within 72 hours after operation. Occurrence of IOUS related adverse events such as brain contusion, cerebral hemorrhage and complications such as intracranial infection and cerebral hematoma were observed. Results The detection rate of tumors by IOUS combined with neuronavigation was 100%(34/34) and accuracy rate of localization was 100%(34/34) in the 34 LGG patients. MRI within 72 hours after operation showed total resection in 27 cases(27/34, 79.41%), subtotal resection in 3 cases(3/34, 8.82%), and partial resection in 4 cases(4/34, 11.76%). Intracranial infection occurred in 2 cases which were improved after anti-infection treatment, but no IOUS scan related adverse events occurred. Conclusion IOUS combined with neuronavigation can accurately locate LGG and achieve maximum extent safely resection of tumors.
Objective To explore the application value of intraoperative ultrasound(IOUS) combined with neuronavigation in the microsurgery of low-grade glioma(LGG). Methods Totally 34 patients with LGG underwent microsurgery assisted by IOUS combined with neuronavigation. The degree of tumor resection was evaluated by MRI within 72 hours after operation. Occurrence of IOUS related adverse events such as brain contusion, cerebral hemorrhage and complications such as intracranial infection and cerebral hematoma were observed. Results The detection rate of tumors by IOUS combined with neuronavigation was 100%(34/34) and accuracy rate of localization was 100%(34/34) in the 34 LGG patients. MRI within 72 hours after operation showed total resection in 27 cases(27/34, 79.41%), subtotal resection in 3 cases(3/34, 8.82%), and partial resection in 4 cases(4/34, 11.76%). Intracranial infection occurred in 2 cases which were improved after anti-infection treatment, but no IOUS scan related adverse events occurred. Conclusion IOUS combined with neuronavigation can accurately locate LGG and achieve maximum extent safely resection of tumors.
引文
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[2] 熊玥,黄伟俊,邱懿德,等.探讨常规术中超声技术在AVM切除术中的应用价值.中国现代药物应用,2017,11(5):24-26.
[3] 陈群帮,付尧,隋国庆,等.超声造影技术在脑肿瘤手术中的应用价值.中华神经外科杂志,2014,30(12):1201-1204.
[4] El Beltagy MA,Aggag M,Kamal M.Role of intraoperative ultrasound in resection of pediatric brain tumors.Childs Nerv Syst,2010,26(9):1189-1193.
[5] 贺焱,何文,杜丽娟,等.术中超声造影对提高脑胶质瘤完全切除的临床应用价值.中华医学超声杂志(电子版),2012,9(1):36-39.
[6] 宋志军,陈晓雷,孙正辉,等.高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响.中华神经医学杂志,2011,10(5):480-484.
[7] Duffau H.Long-term outcomes after supratotal resection of diffuse low-grade gliomas:A consecutive series with 11-year follow-up.Acta Neurochir,2016,158(1):51-58.
[8] 丁宛海,牛朝诗,程伟,等.BOLD-fMRI及DTT技术、术中超声辅助神经导航结合电生理监测在大脑运动区胶质瘤切除术中的应用.中华神经医学杂志,2016,15(8):803-809.
[9] Romano A,D'Andrea G,Calabria LF,et al.Pre- and intraoperative tractographic evaluation of corticospinal tract shift.Neurosurgery,2011,69(3):696-705.
[10] 李晋江,许百男,陈晓雷.颅内肿瘤切除术中脑移位检测和评估方法.中国神经精神疾病杂志,2013,39(5):318-320.
[11] 贾文清,林松,郭志祥,等.术中超声引导切除212例脑胶质瘤.中华神经外科杂志,2010,26(9):781-783.
[12] 王怡,王涌,杨永明.术中超声在神经外科手术中的应用价值.中国医学影像技术,2004,20(2):227-228.
[13] 陈波.脑胶质瘤诊治技术新进展.医学综述,2016,22(14):2765-2768.
[14] 高军喜,姜磊,杨磊,等.术中超声造影在不同级别胶质瘤手术切除中的应用价值.临床超声医学杂志,2015,17(10):658-662.
[15] 王怡,王涌,潘卉雯.颅脑脊髓超声历史进展及现状.肿瘤影像学,2016,25(3):193-195.