Department of Neurooncology, Burdenko Neurosurgery Center, 4-ya Tverskaya-Yamskaya 16 St., Moscow 125047, Russian Federation.
Department of Neurooncology, Burdenko Neurosurgery Center, 4-ya Tverskaya-Yamskaya 16 St., Moscow 125047, Russian Federation.
J Clin Neurosci. 2023 Jun;112:48-54. doi: 10.1016/j.jocn.2023.04.008. Epub 2023 Apr 18.
Our study aimed to compare the differences in quantitative parameters, describing the processes of neurosurgeons' interaction with a microscope when performing traditional and minimally invasive approaches.
We designed a prospective observational study to assess the quantitative parameters of neurosurgeon-microscope interactions. Eighteen patients with intracranial tumors were enrolled in the research. All cases were divided into 2 groups: patients with deep-seated tumors, which were operated on with craniotomy apertures of standard sizes - 3 to 4.5 cm (standard craniotomy SC group) and patients with deep-seated tumors operated on with minimally invasive burr hole approaches with a diameter of 1.4 cm (BH group). Three video cameras were used to register and analyze surgeon-operating microscope interactions. The interaction of the neurosurgeon with the microscope was described by the following parameters: microscope repositioning; time of work at low, medium, and high magnification; and the number of changes in focal length. All the interaction parameters were measured per minute of the microsurgical operation stage.
Nine parameters significantly differed (p value < 0.05) between groups: "total time needed for all microscope positioning adjustments", "number of microscope positioning adjustments per minute","average duration of one microscope position adjustment","operating time at high magnification", "operating time at low magnification","proportion of operating time at high magnification", "proportion of operating time at low magnification", "total time for interaction between neurosurgeon and microscope", "proportion of total time for interaction". Significant P values withstood Benjamini-Hochberg's adjustment for all variables.
The results of the study provide the grounds to postulate that there is a direct and significant relationship between the size of the craniotomy and the frequency of microscope repositioning, as well as the degree of intraoperative microscope magnification.
本研究旨在比较传统入路和微创入路中神经外科医生与显微镜交互作用的定量参数差异。
我们设计了一项前瞻性观察研究，以评估神经外科医生与显微镜交互作用的定量参数。将 18 例颅内肿瘤患者纳入研究。所有病例均分为两组：开颅切口标准尺寸（3-4.5cm）下进行深部肿瘤手术的患者（标准开颅 SC 组）和经直径 1.4cm 微创颅骨钻孔入路手术的患者（BH 组）。使用三个摄像机来记录和分析手术医生与显微镜的交互作用。通过以下参数描述神经外科医生与显微镜的交互作用：显微镜重新定位；低、中、高倍放大工作时间；以及焦距变化次数。所有交互参数均按显微手术操作阶段每分钟进行测量。
9 个参数在组间差异有统计学意义（p 值<0.05）：“所有显微镜定位调整所需的总时间”、“每分钟显微镜定位调整次数”、“每次显微镜定位调整的平均持续时间”、“高倍放大操作时间”、“低倍放大操作时间”、“高倍放大操作时间比例”、“低倍放大操作时间比例”、“神经外科医生与显微镜之间的总交互时间”、“交互总时间比例”。所有变量均经 Benjamini-Hochberg 调整后具有显著 P 值。
研究结果表明，颅骨切开术的大小与显微镜重新定位的频率以及术中显微镜放大程度之间存在直接且显著的关系。
