Hassfeld S, Zöller J, Albert F K, Wirtz C R, Knauth M, Mühling J
Department of Oral and Maxillofacial Surgery, Ruprecht-Karls University of Heidelberg, Germany.
J Craniomaxillofac Surg. 1998 Aug;26(4):220-5. doi: 10.1016/s1010-5182(98)80017-6.
Experience with the commercially available, 3-D navigation systems Viewing Wand (ISG, Mississauga, Ontario, Canada) and SPOCS (Aesculap, Germany) in skull base surgery is presented. Having meanwhile been tested in over 60 clinical trials, the systems achieved an accuracy of < or = 2.7 mm which, at the moment, we deem sufficiently acceptable to proceed with their clinical evaluation. There was no difference in intraoperative accuracy between the mechanical and the optical navigation systems. The systems proved to be very helpful in identifying the extent of the tumours and in visualizing the proximity of vital structures. 3-D-planning, simulation and intraoperative navigation especially facilitates surgery in anatomically complicated situations, without risk of damaging neighbouring structures. The SPOCS (Surgical Planning and Orientation Computer System) revealed a considerably improved flexibility in handling and a better integration into the surgical procedure in comparison with the relatively inflexible and space-demanding Viewing Wand arm. Especially, the 'offset' function of the SPOCS offers the possibility of a virtual elongation of the instrument and thus, in combination with the on-line visualization of the corresponding images, of a 'look ahead' operation. By using computer-assisted simulation and navigation systems, we can expect quality improvement and risk reduction. More extensive and radical interventions seem possible.
本文介绍了在颅底手术中使用市售的三维导航系统Viewing Wand（ISG，加拿大安大略省密西沙加）和SPOCS（德国蛇牌）的经验。这两种系统已在60多项临床试验中进行了测试，其精度达到≤2.7毫米，目前我们认为该精度足以接受，可以继续进行临床评估。机械导航系统和光学导航系统在术中精度方面没有差异。这些系统在确定肿瘤范围和显示重要结构的毗邻关系方面非常有用。三维规划、模拟和术中导航尤其有助于在解剖结构复杂的情况下进行手术，而不会有损伤邻近结构的风险。与相对不灵活且占空间的Viewing Wand臂相比，SPOCS（手术规划与定位计算机系统）在操作灵活性方面有了显著提高，并且能更好地融入手术过程。特别是，SPOCS的“偏移”功能提供了虚拟延长器械的可能性，从而与相应图像的在线可视化相结合，实现“前瞻性”操作。通过使用计算机辅助模拟和导航系统，我们有望提高手术质量并降低风险。似乎可以进行更广泛、更彻底的干预。
