CAJ | 학술논문

目的探讨神经导航结合管状脑牵开器在侧脑室脑膜瘤手术中的应用及其术后远期生存质量.方法回顾性对比分析近3年来经手术治疗的23例侧脑室脑膜瘤患者的临床及随访资料.其中,12例运用神经导航结合管状脑牵开器技术,11例运用传统人工测量解剖标记定位结合传统脑牵开器.对比两组病例在肿瘤切除程度、总体生存率、肿瘤复发率、手术暴露、手术创伤、围手术期并发症及术后生活质量的差别.结果两组肿瘤全切率均达到100％,无围术期死亡,随访期内均未发现肿瘤复发;随访病人总体生存率100％.神经导航结合管状脑牵开器技术不增加并发症发生率(P=0.414),不阻碍术野暴露(P =0.667),不延长手术时间(P =0.695),能够减少术后失语和偏盲的发生(导航组均为0例,传统组分别为2例和3例),可显著缩短切口长度(P =0.034),减小骨瓣大小(P =0.021),减少皮层切开长度(P=0.001),缩短患者术后住院时间(P =0.037),明显改善患者术后生活质量(KPS评分,P=0.029).结论神经导航结合管状脑牵开器技术运用于侧脑室脑膜瘤的显微手术治疗,能够在不降低肿瘤全切除率、不阻碍手术暴露的同时,有效减少手术创伤与围手术期并发症,改善患者术后生活质量,值得进行推广.
목적 탐토신경도항결합관상뇌견개기재측뇌실뇌막류수술중적응용급기술후원기생존질량.방법 회고성대비분석근3년래경수술치료적23례측뇌실뇌막류환자적림상급수방자료.기중,12례운용신경도항결합관상뇌견개기기술,11례운용전통인공측량해부표기정위결합전통뇌견개기.대비량조병례재종류절제정도、총체생존솔、종류복발솔、수술폭로、수술창상、위수술기병발증급술후생활질량적차별.결과 량조종류전절솔균체도100％,무위술기사망,수방기내균미발현종류복발;수방병인총체생존솔100％.신경도항결합관상뇌견개기기술불증가병발증발생솔(P=0.414),불조애술야폭로(P =0.667),불연장수술시간(P =0.695),능구감소술후실어화편맹적발생(도항조균위0례,전통조분별위2례화3례),가현저축단절구장도(P =0.034),감소골판대소(P =0.021),감소피층절개장도(P=0.001),축단환자술후주원시간(P =0.037),명현개선환자술후생활질량(KPS평분,P=0.029).결론 신경도항결합관상뇌견개기기술운용우측뇌실뇌막류적현미수술치료,능구재불강저종류전절제솔、불조애수술폭로적동시,유효감소수술창상여위수술기병발증,개선환자술후생활질량,치득진행추엄.
Objective To study the microsurgical modality for lateral ventricular meningiomas with neuronavigation and tubular retractor system and evaluate its long term outcome.Methods The clinical and follow-up data of 23 lateral ventricular meningioma patients during the past 3 years were collected for a retrospective analysis in our center.12 patients used neuronavigation and tubular brain retractor system,11 patients received traditional manual measurement anatomic landmarks with traditional brain retractor.The tumor resection extent,overall survival,recurrence,operation exposure,operation trauma,peri-operative complications and? post-operative quality of life were compared between two groups.Results The total tumor resection was achieved at 100％ in both groups and the perioperative death or tumor recurrence within the follow-up period was not observed in both groups.The overall survival rate achieved 100％.Neuronavigation combined with tubular brain retractor technology did not increase the overall complications (P =0.414),nor decrease the operative field exposure(P =0.667).Its utility did not extend the operation time(P =0.695),but reduced the occurrence of aphasia and hemianopia after operation and significantly shortened the length of incision (P =0.034),the size of craniotomy (P =0.021),the cortical incision length (P =0.001) and the days of hospitalization (P =0.037).Importantly,neuronavigation with tubular brain retractor system could significantly improve the postoperative quality of life for lateral ventricular meningioma patients(KPS,P =0.029).Conclusions Neuronavigation and tubular brain retractor system used in microsurgical resection of lateral ventricular meningioma doesn' t decrease the total tumor resection and the operation exposure,but reduced intra-operative brain trauma and peri-operation complications.For the improvement of post-operative quality of life,it was suitable for lateral ventricular meningiomas.