无框架脑立体定向手术在微创神经外科中的应用

目的 探讨无框架脑立体定向手术在微创神经外科的应用价值。方法 术前行MRI或CT检查，将数据输入导航系统，进行头颅或脊髓三维模型重建，设计手术切口和入路，术中实时定位。1999年11月－2001年6月进行无框架脑立体定向手术200例，其中颅内动静脉畸形43例，动脉瘤39例，脑膜瘤30例，海绵状血管瘤27例，胶质瘤19例，神经鞘瘤8例，垂体腺瘤5例，血管网织细胞瘤4例，转移癌3例，其他14例；脊髓肿瘤8例。结果 病灶和重要解剖结构定位准确，病灶定位误差均在2mm以内，术后神经功能损害10例，占5．0％，无手术死亡。结论 无框架脑立体定位手术对脑和脊髓手术，尤其是切除脑深部病灶很有帮助，可以准确发现病灶，保护正常神经组织，改变了传统神经外科手术模式，是微创神经外科的保障。

Clinical evaluation of frameless stereotaxy in minimally invasive neurosurgery

Objective To evaluate the utility of frameless stereotaxy in minimally invasive neurosurgery. Methods A retrospective review of 200 cases of craniotomy and laminotomy procedures using frameless stereotaxy systems performed from December 1999 to June 2001 was made, including 43 cases of AVM, 39 cases of aneurysm, 30 of meningioma, 27 of cavenous malformation, 19 of glioma, 8 of neuronoma, 5 of pituitary tumor, 4 of angioreticuloma, 3 of metastatic tumor, 14 cases of craniotomy with other causes, and 8 spinal tumors. Data of MRI or CT, conducted one day before the operation, were entered into the neuronavigation systems and analyzed. A 3 D simulation of model of cranium or spinal cord was reestablished and operative approach was designed. During the operation, the lesion can be located accurately. Results The lesions and important anatomical structures were accurately located and the location errors of lesions were within the limit of 2mm. Postoperative neurological complications occurred only in 10 cases (5.0%). No operative death occurred. Conclusion The frameless stereotaxy is very helpful for brain and spinal surgery, especially for the cases with lesions located deep in the brain. Its accuracy of location is very important in protecting normal brain tissues. The neuronavigation systems are changing the pattern of traditional neurosurgical procedures and serve as the guarantee of minimally invasive neurosurgery.