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目的 评价神经导航系统在经鼻腔蝶窦入路垂体腺瘤切除术中的应用。方法 应用Brain LABVec torVision2 神经导航系统指导手术操作 ,2 1例患者术前行MRI或CT连续薄层扫描 ,将影像学资料输入导航系统计算机工作站 ,标记出肿瘤及重要结构后进行三维重建 ,设计出最佳手术入路 ,术中实时显示来指导定位中线结构、蝶窦前壁、鞍底、海绵窦、颈内动脉和斜坡等结构 ,并用以判断肿瘤的切除程度。结果 2 1例注册误差 0 .3～ 1.8mm(平均 1.13± 0 .38mm) ;所有病例均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位 ;肿瘤全切除 17例 ,次全切除 2例 ,大部切除 2例 ;术后 16例患者症状减轻 ,5例无变化 ,5例出现一过性尿量增多 ,无其他严重并发症。结论 在经鼻蝶显微手术中应用神经导航指导操作 ,手术顺利准确 ,肿瘤切除彻底 ,手术创伤小 ,并发症更少。
Objective To evaluate the application of neuronavigation in resection of pituitary adenomas through nasal sphenoid sinus. Methods Brain LABVec torVision2 neuro-navigation system was used to guide the operation. 21 patients underwent preoperative MRI or CT thin-layer scanning. The imaging data were input into the navigation system computer workstation. The tumors and important structures were marked and reconstructed three-dimensionally. The best surgical approach, intraoperative real-time display to guide the positioning of the midline structure, sphenoid sinus anterior, saddle bottom, cavernous sinus, internal carotid artery and ramps and other structures, and to determine the extent of resection of the tumor. Results 21 cases of registration error 0 .3 ~ 1.8mm (average 1.13 ± 0.38mm); all cases under the guidance of nerve navigation transnasal approach to reach the tumor site; tumor resection in 17 cases, subtotal resection in 2 cases , The majority of resection in 2 cases; postoperative symptoms alleviated in 16 patients, 5 cases no change, 5 cases of transient increase in urine output, no other serious complications. Conclusion In the transnasal microsurgery using neural navigation guidance, the operation is smooth and accurate, complete tumor resection, less surgical trauma and fewer complications.