Neurochirurgische Klinik und Poliklinik, Department of Neurosurgery, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany.
German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Heidelberg, Germany.
Int J Comput Assist Radiol Surg. 2019 Feb;14(2):397-407. doi: 10.1007/s11548-018-1812-9. Epub 2018 Jun 22.
Currently, intraoperative computed tomography (iCT) is a scarcely used technique in neurosurgery. It remains unclear whether this phenomenon is explained by unfavorable iCT-related workflows and/or a limited number of indications. We here analyzed workflows of an installed dual-room iCT (DR-iCT) as compared to surgical procedures lacking iCT. We compared infection rates, utilizations rates, and the spectrum of indications of DR-iCT with that of a previously used single-room iCT.
The study refers to a consecutive series of patients undergoing either single-room iCT (January 2014-August 2014) or DR-iCT (September 2014-July 2016). A further group undergoing surgery without iCT in the interconnected operating rooms represents the reference group. Workflow measurements and infection rates were calculated. Indications for iCT and utilization rates were compared for each of the devices. CT image quality was rated.
Application of DR-iCT led to a broader use of this technique as compared to the single-room device, which concerned in particular stereotactic neurosurgery. Accordingly, iCT utilization rates significantly increased (up to 50.8 ± 4.6 surgeries per month, p < 0.001). Workflow was slightly prolonged in case of DR-iCT imaging; the difference, however, was not statistically significant. Infections rates were low (range 0.0-0.17 infections per month) and not influenced by the utilization rate. Image quality of the DR-iCT was classified as very good in 34/43 evaluated microsurgical patients.
The use of DR-iCT enhances utilization rates with a broader field of indications for intraoperative imaging. Workflow measurements are not significantly prolonged. The technology is safe, and the imaging quality of modern devices can be expected to be good.
目前，术中计算机断层扫描（iCT）在神经外科中很少使用。其原因尚不清楚，这是由于 iCT 相关工作流程不利和/或适应症有限，还是其他原因。本研究分析了安装的双室 iCT（DR-iCT）与无 iCT 的手术程序的工作流程。我们比较了 DR-iCT 和以前使用的单室 iCT 的感染率、使用率和适应症谱。
本研究为连续系列患者，他们接受单室 iCT（2014 年 1 月至 2014 年 8 月）或 DR-iCT（2014 年 9 月至 2016 年 7 月）治疗。在相邻的手术室中无 iCT 的手术患者作为参考组。计算了工作流程测量值和感染率。比较了每种设备的 iCT 适应症和使用率。对 CT 图像质量进行了评分。
与单室设备相比，DR-iCT 的应用导致该技术的使用更为广泛，特别是在立体定向神经外科手术中。因此，iCT 的使用率显著增加（每月高达 50.8±4.6 例手术，p<0.001）。DR-iCT 成像时工作流程略有延长，但差异无统计学意义。感染率较低（每月 0.0-0.17 例感染），且不受使用率的影响。在 43 例接受微手术评估的患者中，有 34 例 DR-iCT 的图像质量被评为非常好。
使用 DR-iCT 可提高术中成像的使用率，并扩大适应症范围。工作流程测量值没有明显延长。该技术安全，并且可以预期现代设备的成像质量良好。
