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本文报告使用作者自行设计制造的,可供电子计算机体层摄影(CT)、核磁共振(MR)和普通X线摄片定位的JP型多功能立体定向仪行CT立体定向脑深部手术52例。其中16例采用通用计算方法,由辅助性微机求出靶点;另36例配用CT适配器,用测量法直接在CT机上定出靶点坐标。80%以上的病灶位于丘脑基底节平面以下。手术类型包括活检、囊肿吸除、血肿穿刺引流、内放射源注入以及配合开颅的定向激光小病灶切除。在含有诊断性目的手术的36例中,术后均获得确定性诊断。其中10例术前诊断困难或与术后病理诊断不相符合。术后死亡3例,轻偏瘫1例。文中对CT定向手术的作用、定位准确性、病例的选择、手术并发症以及该手术的优缺点进行了讨论。
This article reports 52 cases of CT stereotactic deep brain surgery using a JP-type multi-function stereotactic instrument designed by the author and available for electronic computed tomography (CT), nuclear magnetic resonance (MR) and plain radiography. Among them, 16 cases adopted general calculation method, and the target was obtained by auxiliary microcomputer. The other 36 cases were equipped with CT adapter, and the coordinates of target were set directly on CT machine by measuring method. More than 80% of lesions are located below the thalamic basal ganglia plane. Surgical types include biopsy, cyst removal, hematoma puncture and drainage, intracranial injection, and targeted laser mini-lesion with craniotomy. In 36 patients with diagnostic purposes of surgery, postoperative were confirmed by a definitive diagnosis. Among them, 10 cases were difficult to diagnose before operation or did not accord with postoperative pathological diagnosis. Postoperative death in 3 cases, 1 case of hemiparesis. This article discusses the role of CT-oriented surgery, positioning accuracy, the choice of cases, surgical complications and the advantages and disadvantages of the surgery were discussed.