Akhaddar Ali
Department of Neurosurgery, Avicenne Military Hospital of Marrakech and Mohammed V University in Rabat, Marrakech, Morocco.
Surg Neurol Int. 2020 Dec 22;11:461. doi: 10.25259/SNI_791_2020. eCollection 2020.
Intracranial convexity lesions are poorly defined by recognizable anatomical landmarks. Even in expert hands, exact localization of small subcortical lesion and its projection to the skull is sometimes unreliable and can cause potential surgical complications. In this report, a simple and handy technique for localizing superficial intracranial lesions on the scalp under computed tomography (CT)-scan guidance is described.
This technique, HeaDax, is based on using extracranial landmarks. We constructed an isosceles square triangle with three pieces of copper electrical wire and placed it on the skin scalp. Then, we took a CT-scan but without the need of the classic head reference planes (e.g., orbitomeatal or along the orbital roof).
For the measurements, we need to have the intracranial lesion located on the CT slice with respect to the two landmarks which are the height and hypotenuse of the triangle. The promising preliminary results of HeaDax applied to a phantom skull model encourage us to use it successfully for our first patient presenting a right subcortial supramarginal retrorolandic cavernoma.
HeaDax procedure is a good alternative for localizing superficial intracranial lesions on the skin scalp under CT-scan or magnetic resonance imaging guidance. It can be used as a substitute when stereotactic and neuronavigation systems are not easily available, especially in developing countries and in resource-limited environments. HeaDax has a true potential for further developments and applications in cranial surgery.
颅内凸面病变难以通过可识别的解剖标志精确定位。即使是经验丰富的医生，小的皮质下病变的准确定位及其向颅骨的投影有时也不可靠，可能导致潜在的手术并发症。在本报告中，描述了一种在计算机断层扫描（CT）引导下在头皮上定位浅表颅内病变的简单便捷技术。
这种名为“HeaDax”的技术基于使用颅外标志。我们用三根铜质电线构建了一个等腰直角三角形，并将其放置在头皮上。然后，进行CT扫描，但无需使用传统的头部参考平面（如眶耳平面或沿眶顶）。
对于测量，我们需要在CT切片上根据三角形的高和斜边这两个标志来确定颅内病变的位置。HeaDax应用于颅骨模型的初步结果令人鼓舞，促使我们成功地将其用于首例患有右侧皮质下缘上回后罗兰多区海绵状血管瘤的患者。
HeaDax程序是在CT扫描或磁共振成像引导下在头皮上定位浅表颅内病变的良好替代方法。当立体定向和神经导航系统不易获得时，它可用作替代方法，特别是在发展中国家和资源有限的环境中。HeaDax在颅脑手术中有进一步发展和应用的真正潜力。
