Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Germany.
Acta Neurochir (Wien). 2012 Sep;154(9):1663-7. doi: 10.1007/s00701-012-1425-y. Epub 2012 Jul 31.
Frame-based stereotaxy remains the "gold standard" for cerebral biopsies and functional neurosurgery though new frameless stereotactic systems are evolving continually. As the technique of frameless stereotaxy gains increasing acceptance among neurosurgeons, this study assesses the feasibility of a system for frameless image-guided stereotaxy.
All patients biopsied for intracranial lesions between February 2007 and August 2010 using the BrainLAB VarioGuide frameless stereotactic system were evaluated prospectively. Prior to surgery, patients underwent magnetic resonance (MR) imaging; additionally, fluoroethyl-tyrosine (FET)-positron emission tomography (PET) images were acquired and fused to MR images in selected cases. Biopsy trajectory length, lesion volume, procedure duration, and diagnostic yield were assessed.
Ninety-six diagnostic biopsies in 91 patients were evaluated. Lesion volume ranged from 0.17 to 121.8 cm(3); trajectory length from 25.3 to 101.9 mm. Diagnostic yield was 93.8%. Mean operation time from skin incision to wound closure was 42 min; in the operating room, it was 99 min.
Clinical experience indicates VarioGuide to be safe and accurate. Reachable range of lesion localisation appears to be comparable to a frame-based stereotaxy system. Operation times are brief. The unique design of this frameless stereotactic system allows real-time visual feedback of needle positioning.
尽管无框架立体定向系统不断发展，但基于框架的立体定向仍然是脑活检和功能神经外科的“金标准”。随着无框架立体定向技术在神经外科医生中越来越被接受，本研究评估了一种无框架图像引导立体定向系统的可行性。
前瞻性评估 2007 年 2 月至 2010 年 8 月期间使用 BrainLAB VarioGuide 无框架立体定向系统对颅内病变进行活检的所有患者。手术前，患者接受磁共振成像（MR）检查；此外，在选定病例中获取氟乙基酪氨酸（FET）正电子发射断层扫描（PET）图像并与 MR 图像融合。评估活检轨迹长度、病变体积、手术持续时间和诊断率。
91 例患者的 96 例诊断性活检得到评估。病变体积范围为 0.17 至 121.8cm³；轨迹长度范围为 25.3 至 101.9mm。诊断率为 93.8%。从皮肤切口到伤口闭合的平均手术时间为 42 分钟；在手术室中，手术时间为 99 分钟。
临床经验表明 VarioGuide 安全准确。可触及的病变定位范围似乎与基于框架的立体定向系统相当。手术时间短。该无框架立体定向系统的独特设计允许实时视觉反馈针的定位。
