Ternier Jessica, Joshi Shabin M, Thompson Dominic N P
Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Childs Nerv Syst. 2009 May;25(5):563-8. doi: 10.1007/s00381-008-0803-5. Epub 2009 Feb 19.
The study aims to report a preliminary experience of image guidance during transoral surgery in a paediatric population. In paediatric practice, the small size of the oropharynx and the distortion of the craniocervical junction anatomy (whether congenital or acquired) are both factors that may compromise the transoral approach. Prior immobilisation of the craniocervical axis by virtue of posterior fixation or external halo body orthosis permits the use of intra-operative image guidance to navigate this region.
Neuronavigation was used during transoral surgery in six paediatric cases. Preliminary immobilisation of the craniocervical junction was ensured in all patients. Volumetric imaging was then obtained prior to the transoral procedure which was then carried out using neuronavigation assistance (Stealth Station Medtronic). Early post-operative imaging was obtained in each case to assess the extent of the surgical resection.
Neuronavigation was found to correlate well with the intra-operative findings and, in all cases, the surgical objective, decompression of the neuraxis, was achieved. Post-operative imaging reflected the operating surgeon's perception regarding the extent of the decompression. In one case, there was a transient neurological deterioration; there was no mortality and no instances of wound-related complications or cerebrospinal fluid leakage.
Intraoperative neuronavigation during transoral surgery is feasible in the paediatric population. In this unusual patient population, the technique appears to be of value in negotiating complex anatomy and achieving a safe and predictable decompression.
本研究旨在报告在儿科患者经口手术中图像引导的初步经验。在儿科实践中，口咽部尺寸小以及颅颈交界区解剖结构异常（无论是先天性还是后天性），都可能对经口入路造成影响。通过后路固定或外固定颅骨牵引器预先固定颅颈轴，可在术中使用图像引导来探寻该区域。
对6例儿科患者在经口手术中使用神经导航。所有患者均确保对颅颈交界区进行初步固定。然后在经口手术前进行容积成像，随后在神经导航辅助下（美敦力Stealth Station）实施手术。每例患者术后早期均进行成像，以评估手术切除范围。
发现神经导航与术中发现密切相关，并且在所有病例中均实现了手术目标，即神经轴减压。术后成像反映了手术医生对减压范围的判断。1例患者出现短暂性神经功能恶化；无死亡病例，也未出现与伤口相关的并发症或脑脊液漏。
经口手术中使用术中神经导航在儿科患者中是可行的。在这类特殊患者群体中，该技术在处理复杂解剖结构以及实现安全、可预测的减压方面似乎具有价值。
