Chen T C, Rabb C, Apuzzo M L
University of Southern California School of Medicine, Los Angeles.
Neurosurg Clin N Am. 1994 Apr;5(2):261-81.
As neurosurgery moves into the twenty-first century, improved visualization/localization techniques, neuromonitoring, and advanced instrumentation will become standards of care for all intracranial procedures. This article has focused on current available technologies that can be used to facilitate operations on intracranial meningiomas. Preoperative anatomic localization with MR imaging, CT, MR angiography, and angiography are standard techniques. Preoperative functional assessments with MR imaging, magnetic source imaging, PET, and functional MR imaging are crucial to recognize and preserve eloquent adjacent cortex. Pathologic correlations with preoperative imaging (i.e., MR imaging) may help to predict the histopathology. Perioperative rehearsal of the operation can be performed. Intraoperative anatomic localization is important to minimize the craniotomy, dural opening, and passage through normal neural structures. An impressive array of new technologies are currently available, including real-time ultrasonography, frame-based stereotaxy (CT, MR imaging PET), frameless stereotaxy (acoustic localization, neuronavigators, real-time visualization), robotics, neuroendoscopy, and intraoperative dye administration. Increased understanding of the function and individual variability of the human cortex underscores the importance of intraoperative functional localization by electrocorticography and optical imaging. Continuous intraoperative neuromonitoring of sensory (SSEPs, BAERs, visual evoked potentials) and motor evoked potentials is now standard during many intracranial procedures. Complex adjunctive instrumentation, such as the ultrasonic aspirator and the laser, are part of the contemporary armamentarium for meningioma surgery. As we have stated in a previous article, "Developmental trends imply realization of three major directions of technical neurosurgery: (1) precise preoperative simulation, (2) minimization or avoidance of transcranial operative corridors, [and] (3) increased refinement of technical adjuvants--both physical and molecular." The end point of these technical advances is to improve precision and safety and will enhance the outcome in each surgical procedure so that one day we will be able to operate on patients with intracranial lesions with minimal morbidity.
随着神经外科进入21世纪，改进的可视化/定位技术、神经监测和先进的器械将成为所有颅内手术的护理标准。本文重点介绍了目前可用于促进颅内脑膜瘤手术的现有技术。使用磁共振成像（MR成像）、计算机断层扫描（CT）、磁共振血管造影和血管造影进行术前解剖定位是标准技术。使用MR成像、磁源成像、正电子发射断层扫描（PET）和功能磁共振成像进行术前功能评估对于识别和保留明确的相邻皮质至关重要。术前成像（即MR成像）与病理的相关性可能有助于预测组织病理学。可以进行手术的围手术期预演。术中解剖定位对于尽量减少开颅、硬脑膜切开以及通过正常神经结构很重要。目前有一系列令人印象深刻的新技术，包括实时超声、基于框架的立体定向（CT、MR成像、PET）、无框架立体定向（声学定位、神经导航仪、实时可视化）、机器人技术、神经内镜检查和术中染料给药。对人类皮质功能和个体变异性的更多了解凸显了术中通过皮质电图和光学成像进行功能定位的重要性。在许多颅内手术中，连续术中对感觉（体感诱发电位、脑干听觉诱发电位、视觉诱发电位）和运动诱发电位进行神经监测现在已成为标准。复杂的辅助器械，如超声吸引器和激光，是当代脑膜瘤手术器械库的一部分。正如我们在前一篇文章中所述，“发展趋势意味着实现神经外科技术的三个主要方向：（1）精确的术前模拟，（2）最小化或避免经颅手术通道，以及（3）技术辅助手段（包括物理和分子方面）的日益精细化。”这些技术进步的终点是提高精度和安全性，并将改善每台手术的结果，以便有朝一日我们能够以最低的发病率为颅内病变患者进行手术。
