Pojskić Mirza, Bopp Miriam H A, Saβ Benjamin, Carl Barbara, Nimsky Christopher
Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany.
Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany.
Cancers (Basel). 2022 May 6;14(9):2302. doi: 10.3390/cancers14092302.
The aim of surgery for skull base meningiomas is maximal resection with minimal damage to the involved cranial nerves and cerebral vessels; thus, implementation of technologies for improved orientation in the surgical field, such as neuronavigation and augmented reality (AR), is of interest.
Included in the study were 39 consecutive patients (13 male, 26 female, mean age 64.08 ± 13.5 years) who underwent surgery for skull base meningiomas using microscope-based AR and automatic patient registration using intraoperative computed tomography (iCT).
Most common were olfactory meningiomas (6), cavernous sinus (6) and clinoidal (6) meningiomas, meningiomas of the medial (5) and lateral (5) sphenoid wing and meningiomas of the sphenoidal plane (5), followed by suprasellar (4), falcine (1) and middle fossa (1) meningiomas. There were 26 patients (66.6%) who underwent gross total resection (GTR) of the meningioma. Automatic registration applying iCT resulted in high accuracy (target registration error, 0.82 ± 0.37 mm). The effective radiation dose of the registration iCT scans was 0.58 ± 1.05 mSv. AR facilitated orientation in the resection of skull base meningiomas with encasement of cerebral vessels and compression of the optic chiasm, as well as in reoperations, increasing surgeon comfort. No injuries to critical neurovascular structures occurred. Out of 35 patients who lived to follow-up, 33 could ambulate at their last presentation.
A microscope-based AR facilitates surgical orientation for resection of skull base meningiomas. Registration accuracy is very high using automatic registration with intraoperative imaging.
颅底脑膜瘤手术的目的是在对受累脑神经和脑血管损伤最小的情况下进行最大程度的切除；因此，实施如神经导航和增强现实（AR）等可改善手术视野定位的技术备受关注。
本研究纳入了39例连续患者（男性13例，女性26例，平均年龄64.08±13.5岁），他们接受了基于显微镜的AR和术中计算机断层扫描（iCT）自动患者配准的颅底脑膜瘤手术。
最常见的是嗅沟脑膜瘤（6例）、海绵窦（6例）和鞍结节（6例）脑膜瘤、蝶骨内侧（5例）和外侧（5例）翼脑膜瘤以及蝶骨平面（5例）脑膜瘤，其次是鞍上（4例）、大脑镰（1例）和中颅窝（1例）脑膜瘤。26例患者（66.6%）实现了脑膜瘤的全切（GTR）。应用iCT进行自动配准具有很高的准确性（靶配准误差，0.82±0.37毫米）。配准iCT扫描的有效辐射剂量为0.58±1.05毫希沃特。AR有助于在切除伴有脑血管包裹和视交叉受压的颅底脑膜瘤时以及再次手术时进行定位，提高了外科医生的舒适度。未发生关键神经血管结构的损伤。在35例存活至随访的患者中，33例在最后一次就诊时能够行走。
基于显微镜的AR有助于颅底脑膜瘤切除的手术定位。使用术中成像进行自动配准的配准精度非常高。
