Nimsky Christopher, Fujita Atsushi, Ganslandt Oliver, von Keller Boris, Kohmura Eiji, Fahlbusch Rudolf
Department of Neurosurgery, University Erlangen-Nürnberg, Erlangen, Germany.
Neurol Med Chir (Tokyo). 2004 Oct;44(10):522-33; discussion 534. doi: 10.2176/nmc.44.522.
This study evaluated the clinical validity of frameless stereotaxy using high-field intraoperative magnetic resonance (iMR) imaging combined with an in-room neuronavigation system. A 1.5 Tesla MR scanner in conjunction with a ceiling-mounted neuronavigation system was used during 32 frameless stereotaxy procedures consisting of 19 brain biopsies and 13 catheter placements between April 2002 and mid-October 2003. Evaluation of the procedure was based on either the rate of histological diagnostic yield or the ability to accurately position the catheter in the target region. This technique allowed successful registration with a mean error of 1.2 +/- 0.8 mm and resulted in successful placement of the instrument within the target tissue. Intraoperatively, frozen section analysis showed all biopsy samples contained pathological tissue and locations of sampling points were confirmed by iMR imaging. Specific final diagnosis was made in all 19 brain biopsies. The tip of the catheter was successfully placed into the target in all 13 patients confirmed by iMR imaging. The catheter was repositioned based on iMR imaging in four of 13 patients, increasing the rate of successful placement. There were no procedure-related neurological deficits or mortality, but we encountered two cases of wound infection, one needing surgical revision. Total additional procedure time related to the induction of iMR imaging was 76.7 +/- 23.3 minutes. This initial experience of the combination of conventional frameless stereotaxy and high-field iMR imaging improved the quality of frameless stereotaxy with low morbidity and mortality, but did not translate into a significant reduction of procedure-related time.
本研究评估了使用高场术中磁共振成像（iMR）结合室内神经导航系统的无框架立体定向技术的临床有效性。在2002年4月至2003年10月中旬期间，在32例无框架立体定向手术中使用了一台1.5特斯拉的磁共振扫描仪与天花板安装的神经导航系统相结合，这些手术包括19例脑活检和13例导管置入。对该手术的评估基于组织学诊断阳性率或在目标区域准确放置导管的能力。该技术实现了成功配准，平均误差为1.2±0.8毫米，并成功将器械放置在目标组织内。术中，冰冻切片分析显示所有活检样本均包含病理组织，采样点位置经iMR成像确认。所有19例脑活检均做出了明确的最终诊断。13例患者中，导管尖端均经iMR成像确认成功置入目标位置。13例患者中有4例根据iMR成像重新调整了导管位置，提高了成功放置率。未出现与手术相关的神经功能缺损或死亡，但出现了2例伤口感染，其中1例需要手术修复。与iMR成像诱导相关的总额外手术时间为76.7±23.3分钟。传统无框架立体定向与高场iMR成像相结合的这一初步经验提高了无框架立体定向的质量，发病率和死亡率较低，但并未显著减少与手术相关的时间。
