Achey Rebecca L, Karsy Michael, Azab Mohammed A, Scoville Jonathan, Kundu Bornali, Bowers Christian A, Couldwell William T
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States.
J Neurol Surg B Skull Base. 2019 Dec;80(6):626-631. doi: 10.1055/s-0039-1677677. Epub 2019 Jan 21.
Intraoperative navigation during neurosurgery can aid in the detection of critical structures and target lesions. The safety and efficacy of intraoperative, stereotactic computed tomography (CT) in the transnasal transsphenoidal resection of pituitary adenomas were explored. Retrospective chart review Tertiary care hospital Patients who underwent transsphenoidal resection of pituitary adenomas from February 2002 to May 2017. Intraoperative stereotactic CT navigation was used for all patients after mid-October 2013. Operative time, estimated blood loss, gross total resection rate. Of 634 patients included, 175 underwent surgery with intraoperative navigation and 444 had no intraoperative navigation during surgery. There was no difference in mean age, sex, tumor type, or tumor size between the two groups. Operative time, endoscope use, cerebrospinal fluid diversion, and estimated blood loss were also similar. Two patients showed intraoperative, iatrogenic misdirection in the absence of stereotactic CT navigation ( = 0.99) but similar numbers of patients having navigated and non-navigated surgery returned to the operating room, underwent gross total resection, and showed endocrinological normalization. These results suggest that intraoperative navigation can reduce injury without resulting in increased operative time, estimated blood loss, or reduction in gross total resection.
神经外科手术中的术中导航有助于检测关键结构和目标病变。本研究探讨了术中立体定向计算机断层扫描（CT）在经鼻蝶窦垂体腺瘤切除术中的安全性和有效性。
回顾性病历审查
三级医疗中心：纳入2002年2月至2017年5月期间接受经蝶窦垂体腺瘤切除术的患者。2013年10月中旬后，所有患者均采用术中立体定向CT导航。
观察指标：手术时间、估计失血量、肿瘤全切除率。
研究对象：纳入的634例患者中，175例术中采用导航，444例术中未采用导航。两组患者的平均年龄、性别、肿瘤类型或肿瘤大小无差异。手术时间、内镜使用、脑脊液引流和估计失血量也相似。在无立体定向CT导航的情况下，有2例患者出现术中医源性误操作（P = 0.99），但术中采用导航和未采用导航的患者返回手术室、实现肿瘤全切除及内分泌功能恢复正常的人数相近。
研究结论：这些结果表明，术中导航可减少损伤，且不会导致手术时间延长、估计失血量增加或肿瘤全切除率降低。
