Ryken T, Julien T, Frankel B, Canute G, Haller J, Rosenbaum A
Division of Neurosurgery and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and Departments of Neurosurgery and Radiology, State University of New York Health Science Center, Syracuse, New York.
Neurosurg Focus. 1999 Jun 15;6(6):e9. doi: 10.3171/foc.1999.6.6.12.
Transoral odontoidectomy is often performed in the treatment of cervicomedullary junction disease. The operating microscope is frequently used to improve visualization in this narrow field of view. In the setting of complex anatomy or surgical revision the authors hypothesized that combining frameless stereotactic technique with intraoperative microscopy would improve the ability to visualize and identify intraoperative anatomy. In addition they believed that the ability to visualize the targeted region directly in the operating microscope "image injection" would be of particular interest in this setting, provided that sufficient accuracy for use could be obtained in the registration process. The authors assessed the efficacy of this approach in a cadaveric model and obtained sufficient accuracy to warrant use in the operating room. This technique was applied in the surgical management of a 56-year-old woman with rheumatoid arthritis who had undergone a previous decompressive transoral procedure. Subsequently she suffered progressive deterioration and was found to have residual bony compression of the anterior cervicomedullary junction. The authors performed decompressive surgery and obtained satisfactory results by using the image-injected technique, and the patient experienced subsequent clinical improvement. The authors conclude that the image-injected frameless stereotactic technique is of potential benefit, particularly in the narrow window of approach of the transoral odontoidectomy.
经口齿状突切除术常用于治疗颈髓交界处疾病。手术显微镜常用于改善该狭窄视野中的可视化效果。在解剖结构复杂或进行手术翻修的情况下，作者推测将无框架立体定向技术与术中显微镜检查相结合可提高可视化及识别术中解剖结构的能力。此外，他们认为，只要在配准过程中能获得足够的使用精度，在手术显微镜中直接可视化目标区域（“图像注入”）在这种情况下将特别有用。作者在尸体模型中评估了这种方法的有效性，并获得了足以在手术室使用的精度。该技术应用于一名56岁类风湿性关节炎女性患者的手术治疗，该患者此前接受过减压经口手术。随后她病情逐渐恶化，发现颈髓交界处前方存在残余骨质压迫。作者进行了减压手术，通过使用图像注入技术取得了满意的效果，患者随后临床症状改善。作者得出结论，图像注入无框架立体定向技术具有潜在益处，尤其是在经口齿状突切除术的狭窄入路窗口中。
