Klimek L, Laborde G, Mösges R, Wenzel M
Klinik für Hals-Nasen-Ohrenheilkunde und Plastische Kopf- und Halschirurgie, RWTH Aachen.
Unfallchirurg. 1993 Apr;96(4):213-6.
Identification and extraction of penetrating cranial foreign bodies can cause problems in some cases. Small fragments localized deep in the orbit or cerebrum can be especially hard to detect. Severe bleeding and traumatized anatomy can make orientation difficult. We used a new localizing device, computer-assisted surgery (CAS), to good effect in six such cases. CAS is a localizing technique designed to assist the head surgeon during surgery, providing real-time position information. The method is based upon a three-dimensional volume model of the patient's skull generated by preceding computed tomography imaging procedures (CT or MRI). Intraoperative correlation of a 3D-model and the patient's skull allows for real-time position display of a surgical instrument on the monitor screen. Thereby the surgeon is able to localize even small foreign bodies without extensive exploration. In the case of multiple foreign bodies the surgeon calls up a simple documentation facility recording which of the visible fragments have already been extracted. We successfully used the system for extraction of orbital foreign bodies in four and intracerebral foreign bodies in two cases. In a 4-year-old child with gunshot injury the bullet was located in the precentral region and was easily extracted with the CAS system. In a 21-year-old man 39 glass fragments were extracted from the left orbit. In a 36-year-old man a bone fragment was dislocated to the apex of the orbit directly under the optic nerve. Location and extraction were achieved without damage to the orbital structures with the help of the CAS system.
在某些情况下，识别和取出穿透性颅脑异物可能会遇到问题。位于眼眶或大脑深部的小碎片尤其难以检测。严重出血和解剖结构受损会使定位变得困难。我们在6例此类病例中使用了一种新的定位设备——计算机辅助手术（CAS），效果良好。CAS是一种定位技术，旨在在手术过程中协助脑外科医生，提供实时位置信息。该方法基于通过先前的计算机断层扫描成像程序（CT或MRI）生成的患者颅骨三维体积模型。术中将三维模型与患者颅骨进行关联，可在监视器屏幕上实时显示手术器械的位置。这样，外科医生无需进行广泛探查就能定位甚至很小的异物。对于多个异物的情况，外科医生可以调用一个简单的记录工具，记录哪些可见碎片已经被取出。我们成功地使用该系统取出了4例眼眶异物和2例脑内异物。在一名4岁枪伤儿童中，子弹位于中央前区，使用CAS系统轻松取出。在一名21岁男性中，从左眼眶取出了39块玻璃碎片。在一名36岁男性中，一块骨碎片移位到视神经正下方的眶尖。在CAS系统的帮助下，实现了定位和取出，且未损伤眼眶结构。
