Hermann Elvis J, Esmaeilzadeh Majid, Ertl Philipp, Polemikos Manolis, Raab Peter, Krauss Joachim K
Department of Neurosurgery, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany,
Childs Nerv Syst. 2015 Aug;31(8):1327-33. doi: 10.1007/s00381-015-2734-2. Epub 2015 May 2.
Navigated intracranial endoscopy with conventional technique usually requires sharp head fixation. In children, especially in those younger than 1 year of age and in older children with thin skulls due to chronic hydrocephalus, sharp head fixation is not possible. Here, we studied the feasibility, safety, and accuracy of electromagnetic (EM)-navigated endoscopy in a series of children, obviating the need of sharp head fixation.
Seventeen children (ten boys, seven girls) between 12 days and 16.8 years (mean age 4.3 years; median 14 months) underwent EM-navigated intracranial endoscopic surgery based on 3D MR imaging of the head. Inclusion criteria for the study were intraventricular cysts, arachnoid cysts, aqueduct stenosis for endoscopic third ventriculostomy (ETV) with distorted ventricular anatomy, the need of biopsy in intraventricular tumors, and multiloculated hydrocephalus. A total of 22 endoscopic procedures were performed. Patients were registered for navigation by surface rendering in the supine position. After confirming accuracy, they were repositioned for endoscopic surgery with the head fixed slightly on a horseshoe headholder. EM navigation was performed using a flexible stylet introduced into the working channel of a rigid endoscope. Neuronavigation accuracy was checked for deviations measured in millimeters on screenshots after the referencing procedure and during surgery in the coronal (z = vertical), axial (x = mediolateral), and sagittal (y = anteroposterior) planes.
EM-navigated endoscopy was feasible and safe. In all 17 patients, the aim of endoscopic surgery was achieved, except in one case in which a hemorrhage occurred, blurring visibility, and we proceeded with open surgery without complications for the patient. Navigation accuracy for extracranial markers such as the tragus, bregma, and nasion ranged between 1 and 2.5 mm. Accuracy for fixed anatomical structures like the optic nerve or the carotid artery varied between 2 and 4 mm, while there was a broader variance of accuracy at the target point of the cyst itself ranging between 2 and 9 mm.
EM-navigated endoscopy in children is a safe and useful technique enhancing endoscopic intracranial surgery and obviating the need of sharp head fixation. It is a good alternative to the common opto-electric navigation system in this age group.
采用传统技术的导航颅内内窥镜检查通常需要精确的头部固定。对于儿童，尤其是1岁以下的儿童以及因慢性脑积水导致颅骨较薄的大龄儿童，无法进行精确的头部固定。在此，我们研究了电磁（EM）导航内窥镜检查在一系列儿童中的可行性、安全性和准确性，无需精确的头部固定。
17名年龄在12天至16.8岁（平均年龄4.3岁；中位数14个月）的儿童（10名男孩，7名女孩）接受了基于头部三维磁共振成像的EM导航颅内内窥镜手术。该研究的纳入标准为脑室内囊肿、蛛网膜囊肿、脑室解剖结构扭曲的内镜下第三脑室造瘘术（ETV）的导水管狭窄、脑室内肿瘤活检的需求以及多房性脑积水。共进行了22例内窥镜手术。患者仰卧位时通过表面渲染进行导航注册。确认准确性后，将头部稍微固定在马蹄形头架上重新定位进行内窥镜手术。使用引入刚性内窥镜工作通道的柔性探针进行EM导航。在参考程序后以及手术过程中，在冠状面（z = 垂直）、轴位（x = 中外侧）和矢状面（y = 前后）平面上，通过在屏幕截图上测量偏差来检查神经导航的准确性。
EM导航内窥镜检查是可行且安全的。在所有17例患者中，除1例发生出血导致视野模糊，随后我们为该患者进行了无并发症的开颅手术外，均实现了内窥镜手术的目标。对于外耳道、前囟和鼻根等颅外标志物的导航准确性在1至2.5毫米之间。对于视神经或颈动脉等固定解剖结构的准确性在2至4毫米之间变化，而在囊肿本身的目标点准确性变化范围更广，在2至9毫米之间。
儿童EM导航内窥镜检查是一种安全且有用的技术，可增强颅内内窥镜手术，无需精确的头部固定。在该年龄组中，它是常见光电导航系统的良好替代方案。
