【摘要】 目的术中磁共振成像(intraoperative Magnetic Resonance Imaging,iMRI)系统是近年来日渐兴起的先进神经外科手术辅助设备,在垂体腺瘤的微侵袭手术中起到关键作用。文中探讨运用iMRI辅助大型侵袭性垂体腺瘤手术的临床应用价值。方法大型侵袭性垂体腺瘤患者20例,男8例,女12例,经鼻-蝶肿瘤切除术18例,开颅肿瘤切除术2例,均在iMRI系统辅助下行肿瘤显微切除术。术中行MRI扫描1～2次。若术中扫描提示肿瘤残留,则借助iMRI定位并指导手术再次切除残余肿瘤。结果 iMRI扫描发现肿瘤残留者8例,其中6例(30%)做进一步切除;经iMRI再次扫描证实其中4例达全切除,另2例达次全切除;最终16例肿瘤获全切除,4例肿瘤达次全切除,肿瘤的全切率由60%提高至80%,未发现与iMRI相关的并发症。结论 iMRI能有效判断垂体腺瘤的切除程度,为手术结果的实时判断提供客观依据,从而在提高手术精确性和安全性的同时,提高了肿瘤的全切率。更多还原

【Abstract】 Objective Intraoperative magnetic resonance imaging(iMRI),an advancing ancillary technique in neurosurgical procedures for the past few years,is playing a key role in microsurgery for invasive pituitary adenoma.The purpose of this study is to explore the practicability of the resection of large invasive pituitary adenoma by the iMRI-assisted microsurgery and its clinical effects.Methods The microsurgeries assisted by iMRI were performed in 20 patients(8 male and 12 female),including 18 transsphenoidal pituitary adenoma resections and 2 craniotomies.The number of scans ranged from 1 to 2 per surgery.The residual tumors revealed by iMRI were further removed.Results In 8 cases,intraoperative imaging revealed residual tumors,6 of them needed further resections.With the guidance of iMRI,the percentage of gross total removal increased from 60% to 80%.Total and subtotal removals of tumors were achieved respectively in 16 and 4 cases.There was no iMRI-related complication.Conclusion The extent of tumor resection can be assessed effectively by iMRI.Therefore,maximizing the resection of the lesion and minimizing the injury to neurological function can be achieved by iMRI.更多还原