Ikeda K, Shoin K, Taguchi H, Yamano J, Yamashita J
Department of Neurosurgery, National Hospital of Kanazawa.
Neurol Med Chir (Tokyo). 1999 Sep;39(9):701-7; discussion 707-8. doi: 10.2176/nmc.39.701.
Drilling of the skull base bone without damaging the important inside structures and with the correct orientation is very difficult even with the help of the anatomical landmarks. Monitoring of the location and direction of the drill tip and indications of the removed part of the bone during the drilling procedure enhances safety and achieves less invasive neurosurgery. We have developed a novel cranionavigator by combining a high-speed drill with a neurosurgical navigation system. To reduce the positional error to less than 1.5 mm, the position sensor (magnetic field sensor) must be attached 5 cm from the metallic fan portion of the drill and the sensor kept at least 10 cm away from the operating microscope. Simulation studies with the cranionavigator using two dried skulls and three cadaver heads were performed before clinical application. Clinically, this surgical instrument was used in four patients with the skull base tumor. The cranionavigator helped to safely drill the skull base bone in a shorter time by dynamic and real-time display of the precise operating site and extent of bone drilling on the preoperative computed tomography scans or magnetic resonance images. The cranionavigator is a very helpful instrument for skull base surgery in the hands of neurosurgeons with extensive expertise and anatomical knowledge.
即使借助解剖标志，在不损伤重要内部结构且保持正确方向的情况下钻颅底骨也非常困难。在钻孔过程中监测钻头尖端的位置和方向以及所去除骨部分的指征，可提高安全性并实现微创神经外科手术。我们通过将高速钻头与神经外科导航系统相结合，开发了一种新型颅导航仪。为了将位置误差降低到1.5毫米以下，位置传感器（磁场传感器）必须安装在距离钻头金属风扇部分5厘米处，且传感器与手术显微镜保持至少10厘米的距离。在临床应用之前，使用两个干燥头骨和三个尸体头部对颅导航仪进行了模拟研究。临床上，该手术器械用于4例颅底肿瘤患者。颅导航仪通过在术前计算机断层扫描或磁共振图像上动态实时显示精确的手术部位和骨钻孔范围，有助于在更短时间内安全地钻颅底骨。对于拥有丰富专业知识和解剖学知识的神经外科医生来说，颅导航仪是颅底手术中非常有用的器械。
