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背景:肿瘤的切除程度与患者的预后密切相关。神经导航系统可空间追踪立体定向,使术者能够清楚手术野的准确影像学解剖位置,提高肿瘤切除的手术质量。目的:应用神经导航系统对成人幕上胶质瘤实施全切除,并研究其对神经功能的保护作用。设计:以诊断和术后神经功能为依据的回顾性研究。地点和对象:实验地点:北京天坛医院神经外科。对象:1997-2/2000-06收治幕上胶质瘤患者85例,男51例,女34例,年龄17～56岁,肿瘤直径1.8～7.0cm。干预:干预者为所有作者。所有患者实施肿瘤全切除,手术全过程在导航系统引导与监视下进行。主要观察指标:①术后颅脑MRI影像检查。②肿瘤切除后周围组织电镜及病理切片分析。③术后患者以肢体运动功能、语言功能为主的检查结果。结果:肿瘤全切76例,近全切5例,大部切除4例。手术后有49例患者出现明显的神经功能障碍,表现为不同程度的肢体瘫痪和(或)语言障碍,不全偏盲,但全部病例在2个月内恢复,无一例患者留有永久性神经功能障碍。所有8例术前偏瘫的患者在术后短期内症状得到明显改善,均下地行走,karnofaky(KPS)从术前的60～70分增加到80～90分。结论:应用神经导航系统可对大多数大脑半球不同部位胶质瘤患者做到影像学意义肿瘤全切除,并且不引起患者术后永久性神经功能障碍。
Background: The extent of tumor resection is closely related to the prognosis of patients. Nerve navigation system can be stereotaxically tracked space, so that surgeons can clear the surgical field accurate imaging anatomical location, improve the quality of surgical resection of the tumor. OBJECTIVE: To perform total resection of adult supratentorial glioma with neuronavigation system and to study its neuroprotective effect. Design: Retrospective study based on diagnosis and postoperative neurological function. Location and object: Experimental Location: Beijing Tiantan Hospital, Department of Neurosurgery. PARTICIPANTS: Totally 85 patients with gliomas were admitted to the Supratentorial Hospital from 1997-2 / 2000-06. There were 51 males and 34 females, aged from 17 to 56 years. The tumor diameter was 1.8-7.0 cm. Intervention: Intervention is for all authors. All patients underwent total tumor resection, and the entire operation was conducted under the guidance and monitoring of the navigation system. MAIN OUTCOME MEASURES: ① postoperative brain MRI image examination. ② Tumor resected by the surrounding tissue and pathological analysis of electron microscopy. ③ postoperative patients with motor function, language-based test results. Results: Totally 76 cases of tumor resection, nearly complete resection in 5 cases, most resection in 4 cases. After surgery, 49 patients showed obvious neurological dysfunction, manifested as varying degrees of limb paralysis and / or language disorders, partial hemianopia, but all cases recovered within 2 months, and none of the patients had permanent neurological dysfunction . All 8 patients with preoperative hemiplegia had a marked improvement in short-term postoperative symptoms, both walking and Karnofaky (KPS) increased from 60 to 70 preoperatively to 80 to 90 minutes. Conclusion: The application of neuronavigation system in most of the brain hemisphere glioma patients with different parts of the tumor imaging to achieve complete resection, and does not cause permanent postoperative neurological dysfunction.