Hum B, Feigenbaum F, Cleary K, Henderson F C
Imaging Science and Information Systems Center, Georgetown University Medical Center, Washington, District of Columbia, USA.
Neurosurgery. 2000 Aug;47(2):374-80; discussion 380-1. doi: 10.1097/00006123-200008000-00019.
To improve intraoperative observation of unexposed anatomic features and to verify surgical correction, a mobile computed tomographic (CT) scanner has been introduced into the operating room. To date, intraoperative CT scanning has been used predominantly for intracranial procedures. We report on the expanded use of intraoperative CT scanning for spinal surgery, because CT scanning provides excellent observation of osseous pathological features. We report on our first 17 cases, which involved complex craniocervical operations and spinal tumor resections.
The Tomoscan M CT scanner (Philips Medical Systems, Eindhoven, The Netherlands) is mobile and consists of a translatable gantry, a translatable table, and an operator's workstation. In the operating room, the patient is placed on the CT table and prepared in the usual manner. The aperture of the gantry is covered with sterile plastic drapes. The gantry is docked to the table for intraoperative CT scanning as needed for navigation and verification during surgery. Each series of scans requires approximately 15 to 20 minutes.
Our initial experience with neurosurgical spinal cases demonstrated that the use of intraoperative CT scanning changed the course of surgery in 6 of 17 cases. CT scanning was beneficial in facilitating adequate ventral clival and craniocervical decompressions, promoting more complete tumor resections, and verifying correct graft and instrument placement before surgical closing. Other settings in which we have found the mobile CT scanner useful include the neurointerventional suite and the intensive care unit; it is also useful for radiotherapy planning.
On the basis of findings for our first 17 spinal surgery cases, we conclude that intraoperative CT scanning of the spine is both feasible and beneficial for select complex spinal procedures from the craniocervical junction to the sacrum.
为了改善对未暴露解剖特征的术中观察并验证手术矫正效果，一台移动计算机断层扫描（CT）扫描仪已被引入手术室。迄今为止，术中CT扫描主要用于颅内手术。我们报告术中CT扫描在脊柱手术中的扩展应用，因为CT扫描能很好地观察骨质病理特征。我们报告了最初的17例病例，这些病例涉及复杂的颅颈手术和脊柱肿瘤切除术。
Tomoscan M CT扫描仪（飞利浦医疗系统公司，荷兰埃因霍温）是可移动的，由一个可平移的机架、一个可平移的检查床和一个操作员工作站组成。在手术室中，患者被放置在CT检查床上并按常规方式做好准备。机架的孔径用无菌塑料布覆盖。根据手术中导航和验证的需要，将机架对接至检查床进行术中CT扫描。每次扫描系列大约需要15至20分钟。
我们在神经外科脊柱病例方面的初步经验表明，术中CT扫描的使用改变了17例病例中6例的手术进程。CT扫描有助于充分进行腹侧斜坡和颅颈减压，促进更彻底的肿瘤切除，并在手术关闭前验证移植物和器械的正确放置。我们发现移动CT扫描仪有用的其他场景包括神经介入手术室和重症监护病房；它对放射治疗计划也很有用。
基于我们最初17例脊柱手术病例的结果，我们得出结论，对于从颅颈交界到骶骨的特定复杂脊柱手术，术中脊柱CT扫描既可行又有益。
