CAJ | 학술논문

目的评价影像融合神经导航在复发垂体腺瘤或伴蝶窦气化不良的经蝶窦显微外科手术中的应用价值。方法 4年期间选择24例垂体腺瘤患者接受神经导航下经蝶窦手术，其中再次经蝶窦手术者18例，蝶窦气化不良者6例。利用MRI和CT融合图像制定导航计划和引导手术进程。通过对比手术前后影像学资料判断肿瘤切除程度。结果所有肿瘤均通过神经导航准确定位和到达。融合图像可同时显示骨性的蝶窦前壁、蝶窦腔、鞍底和软组织性的肿瘤、颈内动脉、海绵窦及其相互关系。肿瘤全切除20例，次全切除2例，大部切除2例。无颅内出血和感染，短暂性尿崩7例，脑脊液漏和动眼神经麻痹各1例。平均随访17.6个月，22例肿瘤全切除或次全切除者未见复发。结论影像融合神经导航适用于复发垂体腺瘤或伴有蝶窦气化不良者的经蝶窦手术，能准确引导手术进程，避免因定位偏差引起的并发症和有利于肿瘤的全切除。
목적 평개영상융합신경도항재복발수체선류혹반접두기화불량적경접두현미외과수술중적응용개치。방법 4년기간선택24례수체선류환자접수신경도항하경접두수술，기중재차경접두수술자18례，접두기화불량자6례。이용MRI화CT융합도상제정도항계화화인도수술진정。통과대비수술전후영상학자료판단종류절제정도。결과 소유종류균통과신경도항준학정위화도체。융합도상가동시현시골성적접두전벽、접두강、안저화연조직성적종류、경내동맥、해면두급기상호관계。종류전절제20례，차전절제2례，대부절제2례。무로내출혈화감염，단잠성뇨붕7례，뇌척액루화동안신경마비각1례。평균수방17.6개월，22례종류전절제혹차전절제자미견복발。결론영상융합신경도항괄용우복발수체선류혹반유접두기화불량자적경접두수술，능준학인도수술진정，피면인정위편차인기적병발증화유리우종류적전절제。
Objective To evaluate the value of image fusion neuronavigation in transsphenoidal microsurgery for pituitary adenomas of recurrence or associated with poorly pneumatized sphenoid sinus (PPSS). Method During a four - year period, neuronavigation - guided transsphenoidal microsurgery was performed for selected twenty - four patients with pituitary adenoma. Among them, eighteen cases underwent repeat transsphenoidal surgery;six cases associated with PPSS received primary operation. The fused images of magnetic resonance imaging(MRI) and computed tomography(CT) were utilized for preoperative planning and introperative guidance. The extent of tumor removal was determined by the comparative analysis of preand post - operative radiological materials. Results All lesions were accurately oriented and approached with the aid of neuronavigation. Fused images allowed simultaneous visualization of the bony structures (sphenoid wall and cavity,sellar floor) and soft tissue( tumor, internal carotid artery,cavernous sinus) as well as the relationship between them. Total tumor removal was achieved in 20 patients, subtotal and part tumor removal in 2 patients respectively. There was no intracranial hemorrhage and infection. Postoperative transient diabetes insipidus occurred in 7 patients, cerebrospinal fluid leakage and occulomotor palsy in 1 patient respectively. No recurrence was found in the 22 patients with total or subtotal tumor removal during an average 17.6 months follow - up period. ConclusionsImage fusion neuronavigation is beneficial to transsphenoidal microsurgical removal of either recurrent pituitary adenomas or pituitary adenomas associated with PPSS. It may provide accurate guidance for the procedure, avoid complications due to misdirection and achieve a more radical tumor removal.