Application Of Neuronavigaiton Integrated With Intraoperative Ultrasound In Craniocerebral Operaiton

Objective To investigate the clinical value of neuronavigation integrated withintraoperative ultrasound for treating intracranial lesions.We paid attention to thecorrection of brain shift,the value of ultrasound image and operation skills.Methods①We retrospectively analysis the clinical materials of42cases ofintracranial lesions which were resected by intraoperative ultrasound withneuronavigation between January2010to july2011in department of neurosurgery ofaffiliated provincial hospital of anhui medical university.In42cases of intracraniallesions,30cases were males,and12cases were females.The age was between13and70, with anaverage of42.9years old.②The first step was the preoperative planning,We reconstructed thethree-dimensional model of brain and intracranial lesions using the navigation workstation ofBrainlab;The second step was the design of incision,after the head was fixed by DORO orMayfield headstock,the patients were registrated by the way of Softtouch and theaccuracy of navigation was idendified by identifying the tip of the nose.We located theshadow of intracranial lesions in surface of the scalp and designed the best incisionwith the neuronavigation of Brainlab;The third step, we searched and locatedintracranial lesions by intraoperative ultrasound and got the ultrasonoscopy after boneflap removed,The object shift was corrected by intraoperative ultrasound withnavigation. The ultrasonoscopy and the numerical value of object shift was preserved andanalysed after operation;The forth step,after opening the dura, we got the position and distanceof intracranial lesions, then designed the scheme of incising cortex and idendified the accuracyof navigation with intraoperative ultrasound;The fifth step,we could determine the size ofresidual of leisions using intraoperative ultrasound in or after operation.The ultrasonoscopyafter surgery was preserved and used for evaluating the degree of resction.We gotdifferent hyperechogenic of the ultrasonoscopy of intracranial lesion before resection and hypoechogenic of residual cavity after resection. The sixth step, We got CT or T1reinforced phase of intracranial lesions after operation, then evaluated the degree ofresction.Results①In the actual measurement of28cases,brainshift was between3and15mm,with anaverage of5.9mm.The accuracy of localization of intracranial lesions was100%.Intraoperative ultrasound can correct the brain shift of neuronavigation.②Ultrasonic image of HGG was obvious hyperechogenic usually and the boundaries ofHGG was clear usually;Ultrasonic image of LGG was slightly hyperechogenic orisoechogenic and the boundaries of LGG was indistinct usually;Ultrasonic image ofinflammatory and gliosis leisions was unclear usually; Ultrasonic image of meningioma,metastasis, cholesteatoma, Cerebral cysticercosis, choroid plexus papilloma, cavernoushemangioma and lymphadenoma was hyperechogenic usually,their boundaries wasclear usually;Ultrasonic image of brain abscess wall was slightly hyperechogenic,Ultrasonicimage of fester was hypoechogenic;Ultrasonic image of hematoma was obvioushyperechogenic usually,but their boundaries was unclear usually.③We gotinhomogeneous hyperechogenic of the ultrasonoscopy of intracranial lesion beforeresection and hypoechogenic of residual cavity after resection.④Total removal of the lesionswas achieved in37cases,subtotal resection in4cases and partial resction in1case by postoperativeImaging.Hemiplegia happened in1case,visual field defects in1case postoperatively and no death inall the patients.⑤Brain tissue was relatively less injury,and Cerebral cortex was better protected bypostoperative Imaging.Conclusion Intraoperative ultrasound can correct the brain shift,and have clear andimportant value to the choice of operation approach and incising coetex.It have good practicabilityfor adult or child and supratentorial or infratentorial lesions.It have practical value in the findingand localization of deep intracranial lesions.Ultrasonic image of cavernous hemangioma andcalcified lesions is the most clear.Intraoperative ultrasound with neuronavigation can help operator locating the lesions and improve resction rate.