Lauretti Liverana, D'Alessandris Quintino Giorgio, Rigante Mario, Ricciardi Luca, Mattogno Pier Paolo, Olivi Alessandro
Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
Institute of Otorhinolaryngology, Catholic University School of Medicine, Rome, Italy.
World Neurosurg. 2018 Sep;117:103-108. doi: 10.1016/j.wneu.2018.06.015. Epub 2018 Jun 12.
In transsphenoidal endoscopic cranial base surgery, a precise navigational support may be crucial. This is particularly evident when tumors extend to the parasellar region or in recurrent tumors whereas normal anatomy has been altered by previous surgery/radiotherapy.
Previous unsatisfactory experiences with various navigation techniques in this type of surgery encouraged us to perform an endoscopic endonasal approach with an O-arm (Medtronic, Inc., Minneapolis, Minnesota, USA) assisted technique for the surgical treatment of 4 patients affected respectively by an orbital tumor and 3 cases of relapse of nonfunctioning pituitary adenoma, 1 of them localized in the infrasellar-clival region.
The system O-arm-StealthStation allows for merging intraoperative bone 3-D acquisition with preoperative computed tomography/magnetic resonance imaging and provides the surgeon with an extremely reliable operative navigational tool.
This is the first report of an O-arm-assisted endoscopic surgery for cranial base tumors. Here we report on the feasibility and usefulness of such a new application of the O-arm: technical details, setting of the operating room, advantages, and limits of the method are also described. Our overall impression, considering the limited number of patients, is that use of the O-arm may be successfully extended to selected cases of cranial base tumors operated through an endoscopic endonasal approach.
在经蝶窦内镜颅底手术中，精确的导航支持可能至关重要。当肿瘤延伸至鞍旁区域或为复发性肿瘤，而正常解剖结构已因既往手术/放疗而改变时，这一点尤为明显。
此前在这类手术中使用各种导航技术的不尽人意的经历促使我们采用带有O型臂（美敦力公司，美国明尼苏达州明尼阿波利斯）辅助技术的内镜鼻内入路，对4例分别患有眼眶肿瘤的患者以及3例无功能垂体腺瘤复发患者进行手术治疗，其中1例位于鞍下-斜坡区域。
O型臂-神经导航系统能够将术中骨骼三维采集与术前计算机断层扫描/磁共振成像相结合，为外科医生提供极为可靠的手术导航工具。
这是关于O型臂辅助内镜手术治疗颅底肿瘤的首例报告。在此我们报告了O型臂这种新应用的可行性和实用性：还描述了技术细节、手术室设置、该方法的优点及局限性。考虑到患者数量有限，我们的总体印象是，O型臂的应用可成功扩展至经内镜鼻内入路手术治疗的部分颅底肿瘤病例。
