Wei Bin, Sun Guowen, Hu Qingang, Tang Enyi
Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
J Craniofac Surg. 2017 Sep;28(6):1431-1434. doi: 10.1097/SCS.0000000000003624.
As compared with the normal anatomy, structures of the skull base and its surroundings have been dramatically altered of the lesion near the skull base. How to remove the lesion at the skull base was mainly depending on surgeon's personal experience during past years. In this study, the authors explored the safety and accuracy of the surgical navigation system in resecting lesions near the skull base.
The surgical cases consisted of 15 patients who underwent surgery involving the skull base with the using of surgical navigation technology. Five patients had adenoid cystic carcinoma at minor salivary glands of the palate extending to the skull base and 10 patients were suffered from bony ankylosis of temporomandibular joint. After the system converted patient's computed tomography scans into three-dimensional reconstructive images, preoperative planning and simulation of the operation process could be made by surgeons. During the operation, the virtual images were matched with the patient through individual registration. The system provided surgeon with feedback about the operation on the screen instantly with moving the navigated pointer.
The application of surgical navigation system was safe and reliable for resecting the ankylotic bone and identifying the extent of tumors resection near the skull base. No complications including cerebrospinal fluid leak, cranial nerve injuries, severe bleeding happened to those patients.
Given the safety and accuracy of the surgical navigation system, surgery near the skull base appeared to be an ideal field for using with its complex anatomy.
与正常解剖结构相比，颅底及其周围结构因颅底附近病变而发生了显著改变。在过去的几年里，如何切除颅底病变主要取决于外科医生的个人经验。在本研究中，作者探讨了手术导航系统在切除颅底附近病变中的安全性和准确性。
手术病例包括15例使用手术导航技术进行颅底手术的患者。5例患者为腭部小涎腺腺样囊性癌累及颅底，10例患者患有颞下颌关节骨性强直。在系统将患者的计算机断层扫描转换为三维重建图像后，外科医生可以进行术前规划和手术过程模拟。在手术过程中，通过个体配准将虚拟图像与患者进行匹配。该系统通过移动导航指针在屏幕上即时为外科医生提供手术反馈。
手术导航系统在切除强直骨和确定颅底附近肿瘤切除范围方面应用安全可靠。这些患者未发生包括脑脊液漏、颅神经损伤、严重出血在内的并发症。
鉴于手术导航系统的安全性和准确性，颅底附近手术因其解剖结构复杂，似乎是使用该系统的理想领域。
