Otori N, Haruna S, Yoshiyuki M, Moriyama H
Department of Otorhinolaryngology, Jikei University Hospital, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 2000 Jan;103(1):1-6. doi: 10.3950/jibiinkoka.103.1.
We evaluated the advantages and disadvantages of image-guided endoscopic endonasal surgery for various diseases. Thirty-three patients, including 8 with chronic sinusitis, 14 with paranasal cysts, 1 with paranasal tumor (biopsy), 1 with sellaturcial cyst (Rathke's cleft cyst) and 9 with pituitary tumors were endonasally operated on from September 1998 to May 1999, with an electromagnetic navigation system, The Insta Trak (Visualization Technology Inc. USA). The Insta Trak system is composed of a computer, a metal probe with a nonmetallic suction tube attachment, and a soft-type headset with an electromagnetic sensor. This freehand, armless system compensates well for patient's head movement during surgery, and precludes the need for head fixation. Either straight or curved suction tube (probe) can be used to access almost of all pathological sites in the sinus cavity. Location of the metal probe is displayed on the computer moniter as an intersection point on the axial, coronal and sagital CT images. In all cases, Insta Trak showed the surgeon the appropriate location and direction of each lesion. The Insta Trak also indicated the location of the orbit, optic canal, nasolacrimal duct and/or skull base, thus, preventing intraoperative complications. When the anatomy was distorted by previous surgery and/or when there was uncontrollable bleeding from a severe lesion so that the surgeon had difficulty finding the proper orientation, the usefulness of image-guided surgery was sufficiently recognized. However, the following disadvantages were also pointed out. An additional 15 to 20 minutes is needed for equipment set up and operation, unless the surgeon and the operation room staff are familiar with the machine. The patient's CT image used for navigation relies on data obtained preoperatively, that is to say, it can not reflect morphological changes produced during surgery. Moreover, the surgeon must consider possible errors of the navigational point that may result in the headset during surgery, as well as, errors the machine may originally possess. The image-guided system successfully integrated the most up-to-date computer technology with a surgeon's anatomical knowledge for improved treatment of endoscopic endonasal surgery. However, we also concluded that the system should be used as a surgical supporting device for safer and more adequate procedures.
我们评估了影像引导下鼻内镜手术治疗各种疾病的优缺点。1998年9月至1999年5月期间，使用美国可视化技术公司的电磁导航系统Insta Trak，对33例患者进行了鼻内镜手术，其中包括8例慢性鼻窦炎患者、14例鼻旁囊肿患者、1例鼻旁肿瘤（活检）患者、1例鞍隔囊肿（拉克氏裂囊肿）患者和9例垂体瘤患者。Insta Trak系统由一台计算机、一个带有非金属吸引管附件的金属探头以及一个带有电磁传感器的软式头戴设备组成。这种无需手持、无臂的系统能很好地补偿手术过程中患者头部的移动，无需进行头部固定。直的或弯曲的吸引管（探头）均可用于进入鼻窦腔内几乎所有的病变部位。金属探头的位置在计算机显示器上显示为轴向、冠状和矢状位CT图像上的一个交点。在所有病例中，Insta Trak都能向外科医生显示每个病变的合适位置和方向。Insta Trak还能显示眼眶、视神经管、鼻泪管和/或颅底的位置，从而预防术中并发症。当解剖结构因既往手术而变形和/或严重病变导致无法控制的出血，使外科医生难以找到正确的方向时，影像引导手术的作用得到了充分认可。然而，也指出了以下缺点。除非外科医生和手术室工作人员熟悉该设备，否则设备的设置和操作需要额外15至20分钟。用于导航的患者CT图像依赖于术前获得的数据，也就是说，它无法反映手术过程中产生的形态变化。此外，外科医生必须考虑手术过程中头戴设备可能导致的导航点误差，以及设备本身可能存在的误差。影像引导系统成功地将最新的计算机技术与外科医生的解剖学知识相结合，以改进鼻内镜手术的治疗效果。然而，我们也得出结论，该系统应作为一种手术辅助设备，以实现更安全、更充分的手术操作。
