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目的探讨术前功能组织三维可视化及功能信息引导下无框架立体定向导航技术于脑肿瘤切除术中的应用价值。资料与方法将拟行立体导航的患有中央沟附近脑肿瘤的病人随机分配到功能导航组及普通导航组,各30例。功能导航组所有病人均行术前功能组织定位,并将信息导入神经外科导航仪行术中功能区导航。普通导航组病人术中未加入功能信息。比较两组病人手术疗效、肿瘤切除率、运动功能改善情况以及肿瘤病人术后生存质量。结果功能导航组均于术前完成功能组织可视化,且于术中成功标定肿瘤、中央沟及运动区。术中功能信息在开颅前及开颅后均有明显作用。随访结果显示,在手术方式选取(u=2.646,P=0.008)、肿瘤切除率(χ2=7.200,P<0.01)、病人术后运动功能改善情况(u=2.231,P=0.026)及术后生存质量(KPS评分uc=2.664,P=0.008;Zubrod-ECOG-WHO评分uc=2.135,P=0.033)等方面,功能组均优于普通组。结论应用术前功能组织可视化辅助手术计划,实施术中功能信息引导下的神经导航技术,结合术中超声的准确定位,能够正确判断脑功能区与病变的关系,使手术方案个体化,实现在尽可能保护功能区的情况下最大限度切除肿瘤的目的,提高术后病人的生存质量。
Objective To investigate the value of three-dimensional visualization of preoperative functional organization and functional guidance of frameless stereotactic navigation in brain tumor resection. Materials and Methods Patients with brain tumors near the central gully line to be navigated were randomly allocated to functional navigation group and general navigation group, with 30 cases in each group. All patients in the functional navigation group underwent preoperative functional tissue localization and guided the information to the functional area navigation in the neurosurgical navigator. General navigation group patients did not add functional information during surgery. The curative effect, tumor resection rate, improvement of motor function and postoperative quality of life of tumor patients were compared between the two groups. Results The functional navigation group completed visualization of the functional tissue before operation, and successfully calibrated the tumor, central ditch and sports area during operation. Intraoperative information before and after craniotomy have a significant role. The follow-up results showed that the improvement of postoperative motor function (u = 2.231, P = 0.026) and postoperative follow-up of patients with surgical resection (χ2 = 7.200, P = 0.008) The quality of life (KPS score uc = 2.664, P = 0.008; Zubrod-ECOG-WHO score uc = 2.135, P = 0.033) and other functional groups were better than the normal group. Conclusions The preoperative functional tissue visualization assisted surgery plan, the implementation of intraoperative functional information-guided neuro-navigation technology, combined with intraoperative ultrasound accurate positioning, can correctly determine the relationship between brain function area and the lesion, individualized surgical options, to achieve the As far as possible to protect the functional area of the case to maximize the excision of the tumor and improve the quality of life of patients after surgery.