研究神经导航下术中超声联合荧光素钠在脑恶性肿瘤手术中的作用。

回顾性分析深圳市第二人民医院脑科中心自2017年11月27日至2018年3月12日经手术治疗的运动区恶性肿瘤患者9例，所有患者术前均行弥散张量成像（DTI）数据与神经导航融合设计手术入路。术中超声实时定位脑肿瘤并静脉注射荧光素钠使脑肿瘤突显，对比神经导航、超声、荧光素钠3种技术定位肿瘤的一致性，由同一术者在电生理监测下，根据神经导航显示的肿瘤与锥体束的空间关系以及应用荧光素钠显示的肿瘤边界进行肿瘤的切除。

术前神经导航定位肿瘤与椎体束的准确率达100%，剪开硬膜前导航定位肿瘤与超声定位肿瘤一致性达100%，打开硬膜后超声定位的肿瘤位置与荧光染色显示的肿瘤位置一致性达100%。病灶全切除8例（89%），次全切除1例（11%），术后2例患者肌力得到改善，4例患者肌力无减弱，3例患者出现一过性的肌力下降，经康复锻炼后已逐步恢复正常。

神经导航融合DTI可以很好地定位肿瘤与锥体束间的空间关系，术中超声及荧光素钠染色可以实时定位肿瘤，提高肿瘤切除率，降低术后功能障碍发生概率。

To investigate the role of intraoperative ultrasound and sodium fluorescein supported by neuronavigation in microsurgery for malignant neoplasm of cerebrum brain.

A retrospective analysis was conducted on 9 patients with malignant tumors in the sports area from November 27, 2017 to March 12, 2018 in the Brain Center of the Shenzhen Second People’s Hospital. After diffusion tensor imaging (DTI) combined with neuronavigation, all patients were designed for surgical approach. We injected sodium fluorescein into veins before surgery to highlight brain tumors and used intraoperative ultrasound to determine the location of brain tumors. The consistency of tumor localization was compared by neuronavigation, ultrasound and sodium fluorescein. Under electrophysiological monitoring, the tumor resection was performed by the same surgeon based on the spatial relationship between the tumor and the pyramidal tract as shown by neuronavigation and the tumor boundary displayed by sodium fluorescein.

The accuracy of neuronavigation to locate brain tumors and pyramidal tract was achieved in 100% before surgery. The consistency of neuronavigation and ultrasound to locate brain tumors was achieved in 100% before cutting the dura. The consistency of ultrasound and sodium fluorescein to locate brain tumors was achieved in 100% after cutting the dura. Eight patients (89%) underwent total resection and one case (11%) underwent subtotal resection. Muscle strength was improved in 2 patients while 4 patients was the same as before. Three patients experienced a transient decline in muscle strength, which gradually returned to normal after rehabilitation exercise.

Neuronavigation combined with DTI can well define the spatial relationship between tumor and pyramidal tract. Intraoperative ultrasound and sodium fluorescein staining can locate the tumor in real time and increase the tumor resection rate and reduce the probability of postoperative dysfunction.