Lee J Y, Lunsford L D, Subach B R, Jho H D, Bissonette D J, Kondziolka D
Department of Neurological Surgery, Radiation Oncology and Radiology, University of Pittsburgh and Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center-Presbyterian Hospital, Pittsburgh, Pa., USA.
Stereotact Funct Neurosurg. 2000;75(1):35-48. doi: 10.1159/000048381.
Image guidance promotes safe and effective surgical management of a wide array of intracranial diseases. To better define the historical importance of image guidance and to assess the relative contribution of each imaging modality to the safety and efficacy of selected procedures, we reviewed our 20-year experience at a single institution. A retrospective review of our departmental surgical records was performed to identify patients who underwent brain surgery with image guidance between January 1979 and January 1999. We identified the use of intraoperative fluoroscopy, endoscopy, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and angiography in 7,388 patients. During this 20-year interval, advances in neuroimaging were translated into the operating room environment. Fluoroscopic guidance received the highest overall rating and was deemed critical for the performance of successful transsphenoidal surgery (n = 436) and effective percutaneous trigeminal neuralgia management (n = 1,121). Ultrasound and angiography both had limited roles; the latter was important to successful outcomes in 64 patients undergoing aneurysm management (n = 64) and arteriovenous malformation Gamma Knife radiosurgery (n = 786). Endoscopy also had a small role but had limited cost. Beginning in 1982, a dedicated operating room CT scanner was used during both morphologic and functional stereotactic surgery (n = 1,749). After 1986, MRI was used increasingly in the management of selected functional and tumor cases (n = 337); despite great versatility for patients undergoing Gamma Knife radiosurgery, the costs were relatively high. Frameless neuronavigation (n = 263) had excellent versatility and was relatively low in cost. During the last 20 years, image guidance techniques have facilitated minimally invasive brain surgery at our institution. The relative merits of all these imaging tools depended mostly on their versatility and relative costs. Major centers currently contemplating the incorporation of image guidance into routine brain surgery need not reproduce our own learning curve.
影像引导有助于安全、有效地手术治疗多种颅内疾病。为了更好地界定影像引导的历史重要性，并评估每种成像方式对所选手术安全性和有效性的相对贡献，我们回顾了在单一机构的20年经验。对本部门的手术记录进行了回顾性研究，以确定1979年1月至1999年1月期间接受影像引导下脑手术的患者。我们确定了7388例患者术中使用了荧光镜检查、内镜检查、计算机断层扫描（CT）、磁共振成像（MRI）、超声和血管造影。在这20年期间，神经影像学的进展被应用于手术室环境。荧光镜引导获得了最高的总体评分，被认为对于成功进行经蝶窦手术（n = 436）和有效经皮治疗三叉神经痛（n = 1121）至关重要。超声和血管造影的作用都有限；后者对于64例接受动脉瘤治疗（n = 64）和动静脉畸形伽玛刀放射外科治疗（n = 786）的患者取得成功结果很重要。内镜检查的作用也较小，但成本有限。从1982年开始，在形态学和功能立体定向手术（n = 1749）中使用了专用的手术室CT扫描仪。1986年以后，MRI越来越多地用于所选功能和肿瘤病例的治疗（n = 337）；尽管对于接受伽玛刀放射外科治疗的患者具有很大的通用性，但成本相对较高。无框架神经导航（n = 263）具有出色的通用性且成本相对较低。在过去20年中，影像引导技术促进了我们机构的微创脑手术。所有这些成像工具的相对优点主要取决于它们的通用性和相对成本。目前考虑将影像引导纳入常规脑手术的主要中心无需重复我们自己的学习曲线。
