Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2013 Mar-Apr;79(3-4):504-9. doi: 10.1016/j.wneu.2011.09.008. Epub 2011 Nov 7.
We introduce a technique that uses intraoperative flat-panel detector computed tomography (FD-CT) and three-dimensional rotational angiography (3D-RA) acquired in the hybrid operative suite to provide full neuronavigation capabilities during cerebrovascular surgery without the use of preoperative imaging studies.
An Artis Zeego FD system (Siemens AG, Forchheim, Germany), mounted on a robotic C-arm was used during the clipping of an aneurysm to acquire intraoperative FD-CT and 3D-RA images. These images were then fused via the use of BrainLab iPlan 3.0 software and sent to a Vector Vision Sky neuronavigation system (NNS; BrainLAB, Heimstetten, Germany) to provide intraoperative image guidance.
The use of intraoperative FD-CT and 3D-RA with a NNS allowed for accurate visualization of the vascular anatomy and localization of pathology. In a case of a patient harboring two aneurysms, one that was surgically clipped and a second that was treated endovascularly, the 3D-RA clearly showed neck remnants at both aneurysms. Use of the NNS assisted in further clip placement for obliteration of these neck remnants.
Hybrid operating suites equipped with FD-CT, 3D-RA, and NNS capabilities can be used to provide intraoperative 3D image guidance during cerebrovascular surgery with excellent accuracy and without the need for preoperative angiography. Furthermore, this technique required less than 15 minutes for image acquisition and utilizes digitally subtracted angiographic images that are superior to conventional CT or MRI for the imaging of cerebrovascular pathology.
我们介绍一种技术，该技术使用术中平板探测器 CT（FD-CT）和在杂交手术室中获取的三维旋转血管造影（3D-RA），在不使用术前成像研究的情况下，为脑血管手术提供全神经导航功能。
在夹闭动脉瘤期间，使用安装在机器人 C 臂上的 Artis Zeego FD 系统（德国西门子公司，Forchheim）来获取术中 FD-CT 和 3D-RA 图像。然后通过使用 BrainLab iPlan 3.0 软件融合这些图像，并将其发送到 Vector Vision Sky 神经导航系统（NNS；德国 BrainLAB 公司），以提供术中图像引导。
术中 FD-CT 和 NNS 联合使用 3D-RA 可准确显示血管解剖结构和定位病变。在一名患有两个动脉瘤的患者中，一个动脉瘤接受了手术夹闭，另一个动脉瘤接受了血管内治疗，3D-RA 清楚地显示了两个动脉瘤的颈部残端。使用 NNS 有助于进一步夹闭以闭塞这些颈部残端。
配备 FD-CT、3D-RA 和 NNS 功能的杂交手术室可用于在脑血管手术中提供术中 3D 图像引导，具有出色的准确性，并且无需进行术前血管造影。此外，该技术的图像采集时间不到 15 分钟，并且利用数字减影血管造影图像，这些图像优于传统 CT 或 MRI，可用于脑血管病变的成像。
