立体定向锁孔手术显微切除颅内功能区小病灶

立体定向锁孔手术显微切除颅内功能区小病灶 作者：徐侃,陈 鑫,吴新昌,葛忆秦 【关键词】 立体定向；锁孔；微创；功能区小病灶 ［摘要］ 目的 探讨运用立体定向技术行锁孔手术切除颅内功能区小病灶的和疗效。方法 18例颅内功能区小病灶（直径1.5~3 cm）, 使用Leksell-G 立体定向仪，在CT或MR导向下，采用小切口, 环钻开颅；在导针引导下，先行电生理刺激，沿非功能区皮层下斜形径路切除。结果 在Leksell-G定向系统精确定位和电生理刺激下，病灶全切率达100%。本组18例病理结果：脑膜瘤6例,转移瘤6例,炎性肉芽肿4例,海绵状血管瘤1例,胶质瘤1例。术后神经功能保护良好,无手术并发症及死亡。结论 立体定向引导下的锁孔显微手术切除功能区小病灶,是一种定位精确、微创、安全、有效的手术方法。 ［关键词］ 立体定向；锁孔；微创；功能区小病灶 Stereotactic guided “key-hole” microsurgical resection of small intracranial lesions in functional region ［Abstract］ Objective To investigate the operative method and therapeutic effect of stereotactic guided “key-hole” microsurgical resection of small intracranial lesions in functional region.Methods Eighteen patients with small intracranial lesions （with diameter varied between 1.5 and 3 cm） in functional region were involved in this series. MR （CT） guided stereotactic localization was performed with Leksell-G stereotactic system. A little incision was made and the skull was opened with an annular drill. Electrical physiological stimulation was made to get the operative approach avoiding functional region. Then the resection of lesions was executed by leading of guided needle which was fixed according to stereotactic localization. Results All lesions were dissected in total without mortality and neurological deficient. According to pathological examinations, 6 of 18 cases were with meningiomas, 6 with metastatic tumors, 4 with inflammatory granuloma, 1 with cavernous angioma, and 1 with glioma. Conclusion Stereotactic guided “key-hole” microsurgical resection of small intracranial lesions in functional region is an effective and safe operative method with accurate localization and micro invasion. ［Key words］ stereotactic technique;key hole;micro invasion;functional region;small lesions 运用立体定向技术，锁孔微创切除颅内功能区小病灶, 是当今微创神经外科手术的一项新技术。我科于2000年8月~2004年7月应用CT或MR引导，运用脑立体定向技术，在显微镜和电生理刺激器的协助下切除功能区小病灶18例，如下。 1 与方法 1.1 一般资料 本组男12例，女6例；年龄12~64岁,平均40岁。病变部位：中央运动皮层区14例，中央感觉皮层区4例。病变范围：直径最大3 cm，最小1.5 cm。病灶面距脑皮层最短距离为0.4~2 cm。临床症状：癫痫8例、肢体无力6例、感觉障碍4例、言语障碍2例。 1.2 手术方法 局麻下安装Leksell-G立体定向仪框架，行薄层CT或MR增强扫描，选择病灶中心为靶点，确定靶点坐标值及手术切口。术中采用局麻，头皮取3~5 cm半弧形或直切口，2.5~3.5 cm环钻取下骨瓣，十字形切开硬膜，在手术显微镜下剪开蛛网膜，在定位导针引导下，确定病灶的大致范围；用Rdaionics温控射频仪的电生理刺激系统，将电极置于病灶区域的皮层表面，用频率为2 Hz、1 ms诱发运动（安全值参数