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目的 :探讨多模态神经导航融合技术与电生理技术在颅底肿瘤中的应用价值。方法 :21例颅底肿瘤患者进行术前CT、MRI、MRA等影像多模态融合,对病灶进行三维重建,术中实时导航指导手术切除范围;15例颅底附近贴附5个MARK,分别在开骨瓣前及切除病灶后检查是否发生移位,探讨术中持续导航的精确性;对后组颅神经进行全程电生理监测,保护相关颅神经。结果:神经导航具有良好的持续精确性,肿瘤及其周围结构定位准确,在综合的电生理监测下,手术全切除16例(76.2%);次全切3例(14.3%),大部分切除2例(9.5%),术后所有病例全部获得随访,时间6~32个月,远期生活质量KPS评分80~100分,2例复发。结论:颅底肿瘤与颅底组织结构位置相对固定,术中脑移位不明显,对于导航的定位精确性影响较小;术中联合电生理监测技术,及时反馈肿瘤的切除深度,增加手术的安全性的同时加快手术进程,避免脑重要结构的副损伤,两者的联合应用在颅底肿瘤手术中具有重要的临床价值。
Objective: To explore the value of multimodal neural navigation fusion and electrophysiological techniques in skull base tumors. Methods: Twenty-one patients with skull base tumor underwent multimodal fusion of preoperative CT, MRI, MRA and other images. Three-dimensional reconstruction of the lesion was performed. Real-time navigation was used to guide the surgical resection. Fifteen patients with skull base were affixed with 5 MARK In the preoperation and removal of the lesion after the check whether the shift to explore the accuracy of intraoperative continuous navigation; the latter group of cranial nerves electrophysiological monitoring throughout the protection of the cranial nerves. Results: Nerve navigation had good continuous accuracy and accurate positioning of the tumor and its surrounding structures. 16 cases (76.2%) underwent total resection under the comprehensive electrophysiological monitoring, 3 cases (14.3%) underwent subtotal resection and most resections All cases were followed up for 6 to 32 months. The KPS score of long-term quality of life was 80 to 100 and 2 patients relapsed. Conclusion: The skull base tumor is relatively fixed with the structure of the base of the skull, and the intraoperative brain shift is insignificant, which has little effect on the positioning accuracy of the navigation. Combining with the electrophysiological monitoring technique in the surgery, the depth of resection of the tumor is increased in time, Safety and accelerate the surgical process at the same time, avoid the important damage of the important structure of the brain. The combined application of the two has important clinical value in the surgery of skull base tumors.