【摘要】 目的:评价术中超声(intraoperative ultrasound,IOUS)导航技术获取颅脑标准切面声像图,辅助切除颅内微小、深在或边界不清病灶的应用价值。方法:前瞻性地连续募集86例发现颅内微小、深在或边界不清病灶的患者,在手术切除中应用改良IOUS成像技术和手术设置,采集每例患者的标准切面图片(水平、矢状及冠状面)。结果:86个病灶的组织病理学诊断包括海绵状血管瘤、转移性病灶、血管母细胞瘤、胶质瘤和放射性坏死灶。86例患者中,47例(54.7%)符合微小和深在的标准,34例(39.5%)符合边界不清的标准,5例同时符合微小、深在和边界不清的标准。86个病灶均获得水平面标准声像图,而由于技术上的限制,矢状面和冠状面标准声像图分别在52个和46个病灶中获得,13个病灶获得全部3个标准切面声像图。通过IOUS导航技术,所有病灶均成功辨认和定位。共67个病灶(77.9%)进行了完整切除,19个病灶(22.1%)进行了部分切除。结论:根据本研究结果,建议对微小、深在或边界不清的颅内病灶均使用IOUS技术以尽可能获得3个方向上的标准切面声像图。通过应用这一简单的改良技术,神经外科医师可对此类病灶进行精确切除。更多还原

【Abstract】 Objective: Intraoperative ultrasound(IOUS) has been increasingly used as a guiding tool during neurosurgical procedures. In this study, we aimed to evaluate the potential application of IOUS-assisted surgery in the resection of small, deepseated, or ill-defined lesions. Methods: Eighty-six consecutive patients with small, deep-seated, or ill-defined intracerebral lesions were studied prospectively. An improved intraoperative imaging technique and surgical setup were practiced during the surgery. IOUS was performed in three orthogonal imaging planes(horizontal, coronal and sagittal). Results: Histopathological diagnoses of these 86 cases included cavernomas, metastases, hemangioblastomas, gliomas, and radiation necrosis. Forty-seven of the 86 lesions(54.7%) were small and deep-seated, 34(39.5%) were ill-defined, and 5(5.8%) were small, deep-seated, and ill-defined. Sonograms in the horizontal plane were obtained in all 86 cases. Sonograms in the sagittal plane and in the coronal plane were obtained only in 52 cases and in 46 cases, respectively, due to technical limitation. In 13 cases, sonograms in all three orthogonal planes were available. All lesions were successfully identified and localized by IOUS. Total resection was performed in 67 lesions(77.9%) and partial resection was performed in 19 lesions(22.1%). Conclusion: We propose IOUS to be performed in three orthogonal planes when surgery is planned for small, deep-seated, or ill-defined brain lesions. By applying this simple, improved technique, surgeons can perform resection of these lesions precisely.更多还原