Grunert P, Müller-Forell W, Darabi K, Reisch R, Busert C, Hopf N, Perneczky A
Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany.
Comput Aided Surg. 1998;3(4):166-73. doi: 10.1002/(SICI)1097-0150(1998)3:4<166::AID-IGS6>3.0.CO;2-E.
Computed tomography (CT) images in combination with a navigation device enable three-dimensional (3-D) localization of intracranial lesions. Furthermore, CT scanning can be adapted for intraoperative application to actualize the image data and to check the anatomical situation during the operation. Frameless navigation was used in 100 patients. The procedure was performed in 46 cases with an optical navigation system, in 38 cases with a sensory arm, and in 16 cases with a navigated microscope. Six skin markers were used for registration. Mean fiducial registration error was 2.18 mm with a standard deviation of 1.03 mm. The indication for navigation was tumor localization and planning of the craniotomy in 81 cases, stereotactic biopsy in eight cases, and endoscopic procedures in 11 cases. Technical problems with the navigation system were observed in nine cases. In two additional cases the tumor was not found by navigation. All eight biopsy cases were successful, and histologically relevant specimens were obtained without complications. Navigation was helpful in 11 endoscopic cases for choosing an optimal trajectory through the foramen of Monro or for connecting multiple intraventricular cysts. For intraoperative CT imaging, the mobile Philips Tomoscan M was adapted to the needs of the operating environment. The mobile CT was used in 78 cases in the operating room: 16 patients who underwent a stereotactic procedure had only preoperative CT scans, 36 patients had an intraoperative CT during tumor surgery, and 26 patients during the test period of the device had only a postoperative CT investigation. In 10 cases (28%) of the intraoperative group the remaining tumor tissue could be demonstrated on the CT scans. The tumor remnants that were not visible in the microscopical surgical field were subsequently removed. According to our results, intraoperative navigation seems superior for the localization of intracranial lesions and intraoperative CT is more useful when considering the radicality of tumor removal.
计算机断层扫描（CT）图像与导航设备相结合可实现颅内病变的三维（3-D）定位。此外，CT扫描可适用于术中应用，以实现图像数据并在手术过程中检查解剖情况。100例患者使用了无框架导航。该手术在46例患者中采用光学导航系统进行，38例采用传感臂，16例采用导航显微镜。使用六个皮肤标记进行注册。平均基准注册误差为2.18毫米，标准差为1.03毫米。导航的适应证为81例肿瘤定位和开颅手术规划、8例立体定向活检以及11例内镜手术。9例观察到导航系统存在技术问题。另外2例通过导航未发现肿瘤。所有8例活检病例均成功，且获得了组织学相关标本，无并发症。在11例内镜病例中，导航有助于选择通过Monro孔的最佳轨迹或连接多个脑室内囊肿。对于术中CT成像，将移动飞利浦Tomoscan M调整以适应手术环境的需求。在手术室中78例患者使用了移动CT：16例行立体定向手术的患者仅进行了术前CT扫描，36例肿瘤手术患者进行了术中CT扫描，26例在设备测试期间的患者仅进行了术后CT检查。术中组的10例（28%）患者在CT扫描上可显示残留肿瘤组织。随后切除了在显微镜手术视野中不可见的肿瘤残余物。根据我们的结果，术中导航在颅内病变定位方面似乎更具优势，而考虑肿瘤切除的彻底性时，术中CT更有用。
