Ashraf Mohammad, Choudhary Nabeel, Hussain Syed Shahzad, Kamboh Usman Ahmad, Ashraf Naveed
rd Year Medical Student, University of Glasgow, Wolfson School of Medicine, Glasgow, Scotland, United Kingdom.
Visiting Medical Student, Allama Iqbal Medical College, Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan.
Surg Neurol Int. 2020 Aug 15;11:247. doi: 10.25259/SNI_303_2020. eCollection 2020.
Intraoperative imaging addresses the limitations of frameless neuronavigation systems by providing real-time image updates. With the advent of new multidetector intraoperative computed tomography (CT), soft tissue can be visualized far better than before. We report the early departmental experience of our intraoperative CT scanner's use in a wide range of technically challenging neurosurgical cases.
We retrospectively analyzed the data of all patients in whom intraoperative CT scanner was utilized. Out of 31 patients, 24 (77.4%) were cranial and 8 (22.6%) spinal cases. There were 13 male (41.9%) and 18 (58.1%) female patients, age ranged from 1 to 83 years with a mean age of 34.29 years ±17.54 years. Seven patients underwent spinal surgery, 2 cases were of orbital tumors, and 16 intra-axial brain tumors, including 5 low- grade gliomas, 10 high-grade gliomas, and 1 colloid cyst. There were four sellar lesions and two multiloculated hydrocephalus.
The intraoperative CT scan guided us to correct screw placement and was crucial in managing four complex spinal instabilities. In intracranial lesions, 59% of cases were benefitted due to intraoperative CT scan. It helped in the precise placement of ventricular catheter in multiloculated hydrocephalus and external ventricular drain for a third ventricular colloid cyst.
Intraoperative CT scan is safe and logistically and financially advantageous. It provides versatile benefits allowing for safe and maximal surgery, requiring minimum changes to an existing neurosurgical setup. Intraoperative CT scan provides clinical benefit in technically difficult cases and has a smooth workflow.
术中成像通过提供实时图像更新解决了无框架神经导航系统的局限性。随着新型多探测器术中计算机断层扫描（CT）的出现，软组织的可视化效果比以前有了很大改善。我们报告了我们科室在广泛的技术挑战性神经外科病例中使用术中CT扫描仪的早期经验。
我们回顾性分析了所有使用术中CT扫描仪的患者的数据。在31例患者中，24例（77.4%）为颅脑病例，8例（22.6%）为脊柱病例。有13名男性（41.9%）和18名女性（58.1%）患者，年龄范围为1至83岁，平均年龄为34.29岁±17.54岁。7例患者接受了脊柱手术，2例为眼眶肿瘤，16例为脑内肿瘤，包括5例低级别胶质瘤、10例高级别胶质瘤和1例胶样囊肿。有4例鞍区病变和2例多房性脑积水。
术中CT扫描指导我们纠正螺钉放置，并在处理4例复杂的脊柱不稳定情况中起关键作用。在颅内病变中，59%的病例因术中CT扫描而受益。它有助于在多房性脑积水中精确放置脑室导管，并为第三脑室胶样囊肿放置外部脑室引流管。
术中CT扫描安全，在后勤和经济方面具有优势。它提供了多种益处，允许进行安全且最大限度的手术，对现有的神经外科手术设置要求最小的改变。术中CT扫描在技术困难的病例中提供临床益处，并且工作流程顺畅。
