Pollack I F, Albright A L, Adelson P D, Fitz C R
Department of Neurosurgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Pediatr Neurol. 1995 Oct;13(3):209-16. doi: 10.1016/0887-8994(95)00150-e.
The surgical management of children with deep-seated lesions within the brain and skull base or with superficial lesions within functionally important regions of the brain is often challenging. In order to optimize the functional outcome of an affected child, it is essential not only to adequately treat the offending lesion, but also to minimize injury to the surrounding brain. In this study, we examined the applicability of a video-interactive frameless stereotactic system for intraoperative localization and treatment of a variety of pediatric central nervous system problems, including craniotomy for tumor (n = 14), vascular malformation (n = 3), or cortical resection for intractable epilepsy (n = 4); ventricular puncture for shunt insertion in a patient with slit ventricles (n = 2); transoral odontoid resection (n = 1); cannulation of a brainstem syrinx (n = 1); removal of a foreign body (n = 1); and posterior craniocervical decompression (n = 1). The efficacy of the system was judged on several criteria: (1) the accuracy of the targeting achieved; (2) whether the system facilitated treatment of the lesions of interest; and (3) whether neurologic function was preserved. In general, the accuracy of the system for target localization was within 2-4 mm when rigid head fixation was employed intraoperatively. In such cases, frameless stereotactic guidance was extremely helpful in providing rapid and reliable assistance with operative planning, which facilitated the treatment of a variety of lesions in critical areas of brain with minimal neurologic morbidity. Limitations of this technology and potential solutions to these shortcomings are discussed. We conclude that the application of frameless stereotaxis for intraoperative localization represents a major advance in the treatment of a variety of intracranial processes in children by providing a means for accurately directing the approach to and removal of a targeted lesion while minimizing injury to the surrounding brain.
对于患有脑内和颅底深部病变或脑功能重要区域浅表病变的儿童，手术治疗往往具有挑战性。为了优化患病儿童的功能预后，不仅要充分治疗致病病变，还必须尽量减少对周围脑组织的损伤。在本研究中，我们检验了一种视频交互式无框架立体定向系统在术中定位和治疗各种小儿中枢神经系统问题中的适用性，这些问题包括开颅肿瘤切除术（n = 14）、血管畸形切除术（n = 3）、或因顽固性癫痫而行皮质切除术（n = 4）；为裂隙脑室患者插入分流管而行脑室穿刺术（n = 2）；经口齿状突切除术（n = 1）；脑干空洞造瘘术（n = 1）；异物取出术（n = 1）；以及后颅颈减压术（n = 1）。根据以下几个标准判断该系统的疗效：（1）实现的靶点定位准确性；（2）该系统是否有助于治疗感兴趣的病变；（3）神经功能是否得以保留。一般来说，术中采用刚性头部固定时，该系统靶点定位的准确性在2 - 4毫米以内。在这些情况下，无框架立体定向引导对于手术规划提供快速可靠的帮助极为有用，这有助于以最小的神经功能损害治疗脑关键区域的各种病变。讨论了该技术的局限性以及针对这些缺点的潜在解决方案。我们得出结论，无框架立体定向技术在术中定位的应用代表了儿童各种颅内疾病治疗的一项重大进展，它提供了一种准确引导到达并切除目标病变的方法，同时将对周围脑组织的损伤降至最低。
