Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, 779 00, Olomouc, Czech Republic.
Department of Biomedical Engineering, University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc, 779 00, Czech Republic.
BMC Surg. 2021 Jan 23;21(1):58. doi: 10.1186/s12893-021-01066-w.
Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety.
The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7 during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2 system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared.
The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043).
Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.
如今，经鼻内镜颅底入路被广泛应用于前颅窝和中颅窝的各种病变。在这些手术中使用神经导航系统（神经导航）对于深入颅骨内部的定位和提高患者安全性至关重要。
本研究旨在评估光学神经导航与术中 O 臂 O2 成像系统在一组接受经鼻蝶入路垂体腺瘤手术的患者中的应用，并将导航过程中的准确性及其偏差与使用术前 MRI 和 CT 扫描的常规神经导航进行比较。该总体组由 6 名年龄在 39 至 78 岁之间的患者组成，诊断为垂体腺瘤。患者采用内镜经蝶窦技术治疗，所有患者均接受术前脑 MRI 和 CT 扫描。这些图像用于手术中的神经导航系统 StealthStation S7，我们在每个手术患者中定义了两个骨性解剖学标志，例如鼻甲或蝶窦内隔的起点。在神经导航系统下，内镜控制下导航器械的尖端指向这些标志，测量尖端与骨性结构之间的距离。然后，通过移动系统 O-arm O2 系统进行术中 3D X 射线成像，并自动传输到导航系统。在内镜引导下，我们定位了在前一次测量中使用的相同骨性解剖学标志，并在 O 臂获得的图像中重新测量了尖端与骨性标志之间的距离。对这两种测量结果进行了统计学比较。
在使用术前 CT 和 MRI 扫描的常规神经导航中，准确性的平均误差为 2.65 毫米。在术中使用 O 臂的神经导航中，准确性的平均误差为 0 毫米。这些准确性平均误差（通过非参数 Wilcoxon 检验比较两种测量方法）具有统计学显著差异（p=0.043）。
基于这项初步的临床研究，我们得出结论，O 臂能够以临床可行的采集方式提供足够空间分辨率的术中 X 射线 3D 图像。基于颅底 O 臂扫描的术中导航的准确性平均误差明显低于使用常规术前 CT 和 MRI 图像的导航。这表明该方法适合用于内镜经鼻颅底入路。
