Kato A, Yoshimine T, Hirata M, Nakajima S, Maruno M, Taneda M, Hayakawa T
Department of Neurosurgery, Osaka University Medical School, Japan.
Neurol Res. 1998 Dec;20(8):713-8. doi: 10.1080/01616412.1998.11740589.
The approach to the deep-seated angiographic microlesion is often difficult, particularly when it is not demonstrated by computed tomography (CT) or magnetic resonance imaging (MRI). We have developed a method to localize these lesions for open stereotactic surgery employing mobile fluoroscopy. Prior to craniotomy, the patient's head is fixed in a stereotactic frame in a position optimal for the routine microscopic surgery. Following the injection of contrast media, the location of the lesion is marked on the fluoroscope monitor. Under fluoroscopic control, the scalp is marked using radiopaque pointer on each side of the patient's head so that the scalp marks and the target lesion overlap each other on the fluoroscope monitor. Thus the imaginary line connecting these scalp marks passes through the lesion. An additional pair of scalp marks is obtained by changing the projection angle of the fluoroscope. By simple calculation, the coordinates of the lesion are obtained as the nearest point to these two imaginary lines, each of which connects a pair of scalp marks. After craniotomy, the lesion is approached using an open stereotactic technique. The first patient had an aneurysm 1.5 mm in diameter that arose from the feeder of the arteriovenous malformation. The second patient had a small residual nidus of arteriovenous malformation 1.5 cm in diameter in the deep frontal lobe, not recognizable by CT or MRI because of artifacts from a previous surgery. Both patients were successfully operated by employing the present method. This method requires only a conventional stereotactic frame and a mobile fluoroscope, and provides simple and reliable localization of the small lesions recognizable only by cerebral angiography.
对于深部血管造影微病变的处理往往很困难，尤其是当计算机断层扫描（CT）或磁共振成像（MRI）未显示该病变时。我们开发了一种利用移动荧光透视术对这些病变进行定位以便进行开放式立体定向手术的方法。在开颅手术前，将患者头部固定在立体定向框架中，使其处于常规显微手术的最佳位置。注入造影剂后，在荧光透视监视器上标记病变的位置。在荧光透视控制下，使用不透射线的指针在患者头部两侧标记头皮，以便在荧光透视监视器上头皮标记与目标病变相互重叠。这样，连接这些头皮标记的假想线穿过病变。通过改变荧光透视的投影角度可获得另外一对头皮标记。通过简单计算，病变的坐标可作为最接近这两条假想线的点得到，每条假想线连接一对头皮标记。开颅手术后，采用开放式立体定向技术接近病变。首例患者有一个直径1.5毫米的动脉瘤，起源于动静脉畸形的供血动脉。第二例患者在额叶深部有一个直径1.5厘米的小型动静脉畸形残留病灶，由于既往手术的伪影，CT或MRI无法识别。两名患者均采用本方法成功进行了手术。该方法仅需一个传统的立体定向框架和一台移动荧光透视仪，即可对仅通过脑血管造影才能识别的小病变进行简单可靠的定位。
