目的 总结1.5T 术中磁共振成像联合神经导航技术用于脑胶质瘤外科手术的初步经验.方法 回顾49 例脑深层或功能区胶质瘤患者临床资料,分析高场强术中磁共振成像联合神经导航技术对其手术策略、肿瘤切除程度、神经功能保留情况及对神经功能转归的影响.结果 每例患者均于术中行磁共振成像扫描1 ~ 3 次,平均(1.57 ± 0.68)次.首次术中磁共振成像肿瘤全切除者17 例、不同程度肿瘤残留者32 例,显著影响手术策略构成比约为65.31%(32/49).残留者中9 例术中磁共振成像或神经电生理监测提示肿瘤边缘毗邻脑功能区或重要解剖结构,未行全切除;余23 例重新注册经导航指引最终实现影像学全切除.初次手术肿瘤全切除率为34.69%(17/49),术中磁共振成像联合神经导航辅助下实现全切除率46.94%(23/49);最终影像学全切除率提高至81.63%(40/49).术后6 个月随访,19 例神经功能改善,30 例神经功能恢复或接近术前水平;无一例肿瘤进展.结论 高场强磁共振成像联合神经导航技术用于脑胶质瘤外科手术可提高肿瘤全切除率,保护患者神经功能.%Objective To review preliminary experiences in glioma resection in an integrated operating room equipped with 1.5T intraoperative magnetic resonance imaging (iMRI) and neuronavigation. Methods Clinical data of 49 cases of gliomas located in deep brain or eloquent areas were retrospectively analyzed, focusing on the influence of iMRI and neuronavigation on the surgical strategy, the extent of resection and preservation outcomes of patients' neural function. Results iMRI scan were performed in each case for 1 to 3 times, averaging (1.57 ±.68) times. First Imri of 49 cases revealed that 17 cases of gliomas were completely removed, and 32 cases had different residual tumors, indicating that Imri frequently affected or modified the surgical strategy of glioma (32/49, 65.31%). Tumors in 9 cases were not completely removed because diffusion tensor imaging (DTI) navigation and intraoperative neurophysiological monitoring found that the lesions were close to the eloquent areas or deep anatomical structures. Twenty three patients with residual tumors underwent further resection guided by Imri (23/49, 46.94%). As a result, the complete resection rate of tumors increased from 34.69% (17/49) to 81.63% (40/49). Compared to preoperative situation, follow-up study 6 months after the operation found that neural function of 19 cases were improved, and another 30 cases were equal or close to preoperative level without any tumor progression. Conclusion The integration of 1.5T iMRI and neuronavigation helps to maximize the safe removal of the tumors and minimize dysfunction, increasing the accuracy and safety of glioma surgery.
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