Senior B A, Lanza D C, Kennedy D W, Weinstein G S
Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
Arch Otolaryngol Head Neck Surg. 1997 Jul;123(7):706-11. doi: 10.1001/archotol.1997.01900070050008.
To use freehand, real-time, intraoperative, 3-dimensional computed tomography (3-D CT) localization to assist with resection of sinonasal lesions with skull-base and/or orbital extension.
The 3-D CT is computer-assisted technology using the preoperative CT scan as a road map for resection of lesions. Previous technology, while resulting in little intraoperative error, required use of a somewhat cumbersome rigid articulated arm and attached probe, limiting mobility and requiring rigid fixation of the head to maintain system reference. A new freehand version of this technology, eliminating these limitations, has been used for resection of benign sinonasal lesions with skull-base and/or orbital extension.
Tertiary care, university-based practice.
Seven patients prospectively selected with benign lesions involving the sinonasal cavity and orbit and/or skull base.
All patients underwent surgical resection of their tumors using endoscopic, open, or combined procedures with the assistance of freehand 3-D CT localization. MAIN OUTCOME ASSESSMENTS: Surgeon assessment of usefulness.
In several cases, the device assisted the operator in determining the exact location of a displaced optic nerve, ensuring vision preservation, while in other cases, the location and depth of skull-base penetration was clearly determined, allowing resection via a transnasal endoscopic approach. In addition, the device was useful for determining the depth of necessary resection for optimal cosmetic result. In all cases, system accuracy was within less than 2 mm at the operative site. System limitations included need for an additional preoperative CT and time required at the beginning of the case for system setup and registration.
Freehand 3-D CT, while still with limitations, offers the advantage of increased surgical safety, aiding anatomic understanding in distorted surgical fields for resection of benign sinonasal tumors with orbital and skull-base extension.
运用徒手实时术中三维计算机断层扫描（3-D CT）定位技术辅助切除侵犯颅底和/或眼眶的鼻窦病变。
3-D CT是一种计算机辅助技术，它利用术前CT扫描作为病变切除的路线图。以往的技术虽然术中误差较小，但需要使用较为笨重的刚性关节臂和附着的探头，限制了灵活性，并且需要对头进行刚性固定以维持系统参考。这种技术的一种新的徒手版本消除了这些限制，已被用于切除侵犯颅底和/或眼眶的鼻窦良性病变。
以大学为基础的三级医疗实践机构。
前瞻性选择的7例患有累及鼻腔和眼眶及/或颅底的良性病变的患者。
所有患者在徒手3-D CT定位技术的辅助下，采用内镜、开放或联合手术方式进行肿瘤切除。主要结局评估：外科医生对该技术实用性的评估。
在几例病例中，该设备协助术者确定移位视神经的确切位置，确保视力保留，而在其他病例中，清楚地确定了颅底侵犯的位置和深度，从而能够通过经鼻内镜入路进行切除。此外，该设备有助于确定为达到最佳美容效果所需的切除深度。在所有病例中，手术部位的系统精度在2毫米以内。系统的局限性包括需要额外的术前CT以及病例开始时系统设置和注册所需的时间。
徒手3-D CT虽然仍有局限性，但具有提高手术安全性的优势，有助于在切除侵犯眼眶和颅底的鼻窦良性肿瘤时，在变形的手术视野中更好地理解解剖结构。
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