Germano I M, Queenan J V
Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
Comput Aided Surg. 1998;3(1):33-9. doi: 10.1002/(SICI)1097-0150(1998)3:1<33::AID-IGS5>3.0.CO;2-M.
Interactive, image-guided frameless systems are currently used in many centers for navigation during open craniotomies. We report our experience in 34 cases of brain needle biopsy performed with a frameless stereotactic system based on an optical digitizer. Preoperative images were acquired after adhesive skin markers were placed on the patient's head. Biopsy planning was done on the computer monitor using triplanar and 3-dimensional reformatted images. All biopsies were performed under local anesthesia through a twist drill craniostomy. The biopsy guide consisted of a rigid canula stabilized by a self-retaining retractor arm attached to the reference arc placed around the patient's head in the operating room. The position of the probe tip and its ideal continuation were displayed on real-time reformatted images and compared with the previously obtained trajectory plan. The position of the probe was adjusted as necessary to align it accurately with the surgical trajectory calculated by the computer in angles and displayed on the computer images. Diagnostic tissue was obtained in all cases; the mean and standard deviation of the maximum longitudinal diameter of the lesions was 3.5 +/- 1.1 cm. All patients reported minimal discomfort during the procedure; there was no operative morbidity or mortality. Our experience suggests that interactive image-guided frameless stereotactic brain needle biopsy successfully provides diagnostic tissue.
交互式图像引导无框架系统目前在许多中心用于开颅手术中的导航。我们报告了使用基于光学数字化仪的无框架立体定向系统进行34例脑针活检的经验。在患者头部放置皮肤粘贴标记后获取术前图像。使用三平面和三维重建图像在计算机显示器上进行活检规划。所有活检均在局部麻醉下通过环钻颅骨造口术进行。活检导向器由一个刚性套管组成，该套管由一个自固定牵开器臂稳定，该牵开器臂连接到手术室中围绕患者头部放置的参考弧上。探头尖端的位置及其理想的延伸方向显示在实时重建图像上，并与先前获得的轨迹计划进行比较。必要时调整探头位置，使其在角度上与计算机计算的手术轨迹精确对齐，并显示在计算机图像上。所有病例均获得诊断性组织；病变最大纵向直径的平均值和标准差为3.5 +/- 1.1厘米。所有患者在手术过程中均报告不适轻微；无手术并发症或死亡。我们的经验表明，交互式图像引导无框架立体定向脑针活检成功地提供了诊断性组织。
