神经导航联合术中超声在高级别胶质瘤切除术中的应用

发布时间：2018-01-28 07:58

本文关键词： 神经导航术中超声术中多点病理学报告高级别胶质瘤　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨神经导航联合术中超声在高级别胶质瘤切除手术中的作用和价值。方法(1)收集2014年1月至2016年10月我院20例术前拟诊断且术后病理学确诊为高级别胶质瘤的患者的临床资料,20例恶性胶质瘤患者中,女性8例,男性12例。最大年龄71岁,最小5岁。平均年龄43岁。(2)患者均术前使用MRI介导的神经导航系统制定最佳的手术方案;打开脑硬膜前应用神经导航定位肿瘤边界,融合术中B超声验证;术中应用超声及导航引导显微镜下切除肿瘤病变,实时术中超声纠正导航图像偏移并检查切除肿瘤的体积;使用术中超声、神经导航下观察选取的肿瘤影像学边界多点术中病理学报告判断病变切除的程度和范围。(3)根据术后72小时增强MRI结果判断患者肿瘤切除程度并随访患者术后恢复情况。结果经导航系统有助于制定最优化的手术治疗方案,对病变定位准确率为100%;神经导航结合术中实时超声能显著提高肿瘤的全切除率及神经功能保护;术中超声、神经导航结合显微镜下观察选取的肿瘤影像学边界多点术中病理学检查能较精确判定肿瘤的生物学边界,提高切除范围;在其指导下16例获得全切除,4例获得次全切除;术后无严重并发症病例,无死亡病例。结论经导航联合术中超声及在显微镜下观察下选取肿瘤边界多点术中病理指导显微神经外科手术能提高高级别胶质瘤“安全最大化切除”率;为多模态技术下精准手术治疗提供临床依据;为术后的精准适型放射治疗及综合治疗提供良好的基础。
[Abstract]:Objective to evaluate the role and value of neuronavigation combined with intraoperative ultrasound in the resection of high grade gliomas. From January 2014 to October 2016, the clinical data of 20 patients with high grade glioma were collected. Of the 20 patients with malignant glioma, 8 were female and 12 were male. The oldest age was 71 years. Patients with the youngest age of 5 years with an average age of 43 years were treated with MRI-mediated neuronavigation system before operation to make the best operation plan. Neuronavigation was used to locate the margin of the tumor before opening the dura dural, and B-mode ultrasound was used to verify the localization of the tumor. Intraoperative ultrasound and navigation guided microscope were used to remove tumor lesion, real-time ultrasound was used to correct the deviation of navigation image and the volume of tumor was examined. Use intraoperative ultrasound. Evaluation of the extent and extent of resection of lesions by intraoperative pathology report of selected tumor imaging boundary under neuronavigation. According to the results of enhanced MRI at 72 hours after operation, the degree of tumor resection was evaluated and the postoperative recovery was followed up. Results the navigation system was helpful to make the optimal surgical treatment. The accuracy of localization was 100%. Neuronavigation combined with intraoperative real-time ultrasound could significantly improve the rate of total resection and the protection of neural function. Intraoperative ultrasound, neuronavigation combined with microscope observation of tumor imaging boundary multi-point intraoperative pathological examination can more accurately determine the biological boundary of the tumor, improve the scope of resection; Under its guidance, 16 cases received total resection and 4 cases got subtotal resection. There were no serious complications after operation. Conclusion guided by navigation combined with intraoperative ultrasound and microscopically observed multiple points of tumor boundary, microneurosurgery can improve the rate of "safety maximization resection" of high grade gliomas. To provide the clinical basis for the precise surgical treatment under the multi-modal technology. It provides a good basis for accurate and comprehensive radiotherapy after operation.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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