Bootz F, Schulz T, Weber A, Scheffler B, Keiner S
Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany.
Comput Aided Surg. 2001;6(5):297-304. doi: 10.1002/igs.10017.
Intraoperative imaging in head and neck surgery is a useful tool in many situations. In addition to being helpful for intraoperative orientation, real-time imaging enables visualization of the progress of surgery and the completeness of tumor resection. Regions in the head and neck to which access is difficult, and which therefore have a high incidence of morbidity and risk for the patient, can be approached more easily and safely in an open MRI than in a conventional way. Interventions in the open MRI (Signa SP, 0.5 Tesla) were performed with nonmagnetic instruments and an MR-safe microscope. For intraoperative navigation, the integrated FlashPoint system is helpful, because it allows targeting of the tumor by a calculated virtual line. T1W spin-echo, T2W fast spin-echo, and 3D T1W gradient-echo sequences were used for high-resolution imaging. Real-time imaging is achieved by fast multiplanar spoiled gradient-echo sequences or T2 single-shot fast spin-echo sequences. From 1996 to the present, we biopsied 17 petroclival tumors, performed paranasal sinus surgery in five cases, biopsied two neck masses, and inserted tubes for brachytherapy in 12 cases. No complications were observed. In all surgical procedures, a good resolution was obtained with MRI, especially for soft-tissue structures. The tumor could be targeted exactly, and all specimens revealed the relevant histology. In paranasal sinus surgery, however, the success rate was lower because it was difficult to distinguish blood from pathologic tissue. The insertion of tubes for brachytherapy was successful in all cases. It was possible to apply the tubes parallel to each other, 1 cm apart. Relevant biopsies could be taken of both neck masses. The indications for the use of open MRI in otorhinolaryngology are biopsies of tumors in regions that are difficult to approach, such as the petrous apex and petroclival region, the parapharyngeal space, and the orbit. Furthermore, the open MRI can be useful in paranasal sinus surgery, in the evaluation of tissue resection, and in the detection of the anatomy of delicate structures such as the internal carotid artery, the skull base, and the orbit. In addition, active navigation in the open MRI is possible with the integrated FlashPoint system. The advantage over conventional navigation systems lies in the possibility of real-time imaging, which allows detection of tissue changes occurring during the procedure.
头颈部手术中的术中成像在许多情况下都是一种有用的工具。除了有助于术中定位外，实时成像还能使手术进展和肿瘤切除的完整性可视化。与传统方式相比，在开放式磁共振成像（MRI）中更容易、更安全地接近头颈部中难以触及且患者发病率和风险较高的区域。在开放式MRI（Signa SP，0.5特斯拉）中进行干预时使用了非磁性器械和磁共振安全显微镜。对于术中导航，集成的FlashPoint系统很有帮助，因为它允许通过计算出的虚拟线靶向肿瘤。T1加权自旋回波、T2加权快速自旋回波和3D T1加权梯度回波序列用于高分辨率成像。通过快速多平面扰相梯度回波序列或T2单次激发快速自旋回波序列实现实时成像。从1996年至今，我们对17例岩斜区肿瘤进行了活检，对5例患者进行了鼻窦手术，对2例颈部肿块进行了活检，并对12例患者进行了近距离放射治疗插管。未观察到并发症。在所有手术过程中，MRI均获得了良好的分辨率，尤其是对软组织结构。肿瘤能够被精确靶向，所有标本均显示出相关组织学特征。然而，在鼻窦手术中，成功率较低，因为难以区分血液和病理组织。近距离放射治疗插管在所有病例中均成功插入。可以将插管彼此平行插入，间隔1厘米。对两个颈部肿块均进行了相关活检。在耳鼻喉科使用开放式MRI的适应证包括对难以触及区域的肿瘤进行活检，如岩尖和岩斜区、咽旁间隙和眼眶。此外，开放式MRI在鼻窦手术、组织切除评估以及检测颈内动脉、颅底和眼眶等精细结构的解剖方面可能有用。此外，使用集成的FlashPoint系统在开放式MRI中进行主动导航是可行的。与传统导航系统相比，其优势在于能够进行实时成像，这使得在手术过程中能够检测到组织变化。
