Freyschlag Christian F, Kerschbaumer Johannes, Eisner Wilhelm, Pinggera Daniel, Brawanski Konstantin R, Petr Ondra, Bauer Marlies, Grams Astrid E, Bodner Thomas, Seiz Marcel, Thomé Claudius
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
World Neurosurg. 2017 Jan;97:669-673. doi: 10.1016/j.wneu.2016.10.091. Epub 2016 Oct 27.
Optical neuronavigation without rigid pin fixation of the head may lead to inaccurate results because of the patient's movements during awake surgery. In this study, we report our results using a skull-mounted reference array for optical tracking in patients undergoing awake craniotomy for eloquent gliomas.
Between March 2013 and December 2014, 18 consecutive patients (10 men, 8 women) with frontotemporal (n = 16) or frontoparietal (perirolandic; n = 2) lesions underwent awake craniotomy without rigid pin fixation. All patients had a skull-mounted reference array for optical tracking placed on the forehead. Accuracy of navigation was determined with pointer tip deviation measurements on superficial and bony anatomic structures. Good accuracy was defined as a tip deviation <2 mm.
Gross total resection (>98%) was achieved in 7 patients (38%); >90% of tumor was resected in 8 patients (44%). In 3 patients, only subtotal resection or biopsy was performed secondary to stimulation results. In all patients, good accuracy of the optical neuronavigation system could be demonstrated without intraoperative peculiarities or complications. The reference array had to be repositioned because of loosening in 1 patient. Neuronavigation could be reliably applied to support stimulation-based resection.
A skull-mounted reference array is a simple and safe method for optical neuronavigation tracking without rigid pin fixation of the patient's head.
在清醒手术过程中，由于患者的移动，未对头进行刚性针固定的光学神经导航可能会导致结果不准确。在本研究中，我们报告了在接受清醒开颅手术切除明确的胶质瘤患者中使用颅骨安装参考阵列进行光学跟踪的结果。
在2013年3月至2014年12月期间，18例连续患者（10例男性，8例女性），患有额颞叶病变（n = 16）或额顶叶（中央沟周围；n = 2）病变，接受了无刚性针固定的清醒开颅手术。所有患者均在额头上放置了用于光学跟踪的颅骨安装参考阵列。通过对浅表和骨性解剖结构进行指针尖端偏差测量来确定导航的准确性。良好的准确性定义为尖端偏差<2毫米。
7例患者（38%）实现了大体全切除（>98%）；8例患者（44%）切除了>90%的肿瘤。3例患者因刺激结果仅进行了次全切除或活检。在所有患者中，光学神经导航系统的准确性良好，术中无特殊情况或并发症。1例患者因松动不得不重新定位参考阵列。神经导航可可靠地应用于支持基于刺激的切除。
颅骨安装参考阵列是一种简单安全的方法，用于在不对患者头部进行刚性针固定的情况下进行光学神经导航跟踪。
