Neurosurgery Clinic, Heinrich-Heine University, Düsseldorf, Germany.
Neurosurgery. 2010 Apr;66(4):784-7. doi: 10.1227/01.NEU.0000367450.79418.5B.
Exact intraoperative localization of pathologies in spinal and peripheral nerve surgery is not easily achieved. In spinal surgery, intraoperative fluoroscopy is the common method for identification of the level affected. It seldom visualizes the pathology itself and is prone to error in identifying anatomic disorders and superimposing structures. In peripheral nerve surgery, intraoperative fluoroscopy is of little value. The present technical study was conducted to evaluate the feasibility of using a preoperative computed tomography-guided needle marking system, which was previously developed for use in gynecology. The goal was to reduce intraoperative localization error and radiation exposure to patients and operating room personnel.
We used a flexible hooked-wire needle marking system, which has previously been used for preoperative marking of breast lesions, to localize and tag spinal and peripheral nerve pathologies. Marking was carried out under computed tomographic control before surgery. Seven illustrative cases were chosen for this report: 6 patients with disorders of the spine and 1 patient with a peripheral nerve schwannoma.
No adverse reactions, aside from minor discomfort, were observed in this study. In all cases, the needle could be used as a reliable guide for the surgical approach and led directly to the pathology. In no case was additional intraoperative fluoroscopy needed. The level of radiation exposure to the patient as a result of computed tomography-based marking was similar to or less than that encountered in conventional intraoperative x-ray localization. Radiation exposure to the operating room personnel was eliminated by this method.
Preoperative marking of spinal level or peripheral nerve pathologies with a flexible hooked-wire needle marking system is feasible and appears to be safe and useful for neurosurgical spinal and peripheral procedures.
在脊柱和周围神经外科手术中，很难精确地进行术中定位。在脊柱手术中，术中透视是确定受累水平的常用方法。它很少能直接显示病变本身，并且容易在识别解剖紊乱和叠加结构时出错。在周围神经外科手术中，术中透视几乎没有价值。本技术研究旨在评估一种术前 CT 引导的针标记系统的可行性，该系统之前已用于妇科。目的是减少术中定位误差和减少患者和手术室人员的辐射暴露。
我们使用了一种以前用于术前标记乳房病变的灵活钩状针标记系统来定位和标记脊柱和周围神经病变。标记是在手术前进行 CT 控制下进行的。本报告选择了 7 个说明性病例：6 例脊柱疾病患者和 1 例周围神经神经鞘瘤患者。
除了轻微不适外，本研究未观察到不良反应。在所有情况下，针都可以作为手术入路的可靠指南，并直接引导至病变。在没有情况下需要额外的术中透视。与常规术中 X 射线定位相比，基于 CT 的标记对患者的辐射暴露程度相似或更低。该方法消除了手术室人员的辐射暴露。
使用柔性钩状针标记系统对脊柱水平或周围神经病变进行术前标记是可行的，并且似乎对神经外科脊柱和周围手术安全且有用。
