Kiya N, Dureza C, Fukushima T, Maroon J C
Department of Neurosurgery, Allegheny General Hospital, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania, USA.
Minim Invasive Neurosurg. 1997 Sep;40(3):110-5. doi: 10.1055/s-2008-1053429.
Frameless navigational devices have recently undergone an evoluation to the point where they are being used more efficiently in the clinical setting. Most of the present-day systems utilize some form of mechanical arm to correlate registered points in space to the computer terminal. However, the articulated arm can be cumbersome and is an additional obstacle in the surgical field. To avoid this problem some groups have elected to transmit registered points and probe position using ultrasound or electromagnetic fields. However, in using magnetic fields, ferromagnetic metals can interfere with accuracy. On the other hand with ultrasonic digitizers accuracy is dependent on variable factors such as humidity, local temperature, and positioning of the emitters. In response to some of these difficulties inherent with frameless stereotaxy, the MKM system was developed. Essentially it is an optically based system in which the CT and/or MRI data are superimposed three-dimensionally onto the surgical field as seen through the microscope using head-up display technology. It requires no opto-kinetic link such as a headframe, mechanical arm, ultrasonic, and magnetic field. We have used the MKM microscope system to guide 18 neurosurgical procedures. This report illustrates the advantages of this system when combined with keyhole surgery to provide accurate excision of brain lesions while preserving normal tissue.
无框架导航设备最近经历了一次演变，发展到如今在临床环境中得到了更高效的使用。目前大多数系统利用某种形式的机械臂将空间中的注册点与计算机终端相关联。然而，关节臂可能很笨重，并且是手术区域中的一个额外障碍。为避免此问题，一些团队选择使用超声或电磁场来传输注册点和探头位置。然而，在使用磁场时，铁磁性金属会干扰准确性。另一方面，对于超声数字化仪，准确性取决于诸如湿度、局部温度和发射器位置等可变因素。针对无框架立体定向技术中固有的一些此类困难，开发了MKM系统。本质上，它是一个基于光学的系统，其中CT和/或MRI数据通过平视显示技术以三维方式叠加到通过显微镜看到的手术区域上。它不需要诸如头架、机械臂、超声和磁场等视动链接。我们已经使用MKM显微镜系统指导了18例神经外科手术。本报告说明了该系统与锁孔手术相结合时的优势，即在保留正常组织的同时准确切除脑病变。
