影像导航下经鼻内镜视神经减压术(附12例临床分析)

Application of image guidance system in endoscopic optic nerve decompression

目的探讨影像导航技术在经鼻内镜的视神经减压术中应用的有关问题。方法回顾性分析本科自2005-2006年收治的视神经损伤性病变12例，均在影像导航下经鼻内镜行视神经减压手术。结果影像导航术前准备时间（包括配准、头架定位、常规器械注册等）5～10min，平均7min。手术区域影像标志与实体解剖标志间的误差≤1．5m。4例术前无光感者术后2例有效，其余8例有残存光感者术后5例有效（视力提高1个级别以上）。结论影像导航系统与鼻内镜相结合下的视神经减压术，可以帮助术者在影像导航下准确定位视神经管，颈内动脉等重要标志，并可清晰显示其毗邻关系，可提高手术的精确性和安全性。尤其体现在局部解剖结构因外伤导致的毗邻关系改变的情况下行手术。

Objective To investigate the advantages of image-guidance system m Endoscopic optic nerve decompression. Methods Retrospective review of 12 imaging-guidance systems endoscopoc optic nerve decompression at our department between May 2005 and May 2006. Results The preoperative preparation time would take 5-10 minutes, including coordination, head holder localization, conventional instrument registration. In our cases, the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1. 5 mm. 2 of 4 cases with no light perception were effective. Five of eight cases with light perception or higher grades had improvemented. Conclusion Image guidance system combined with endoscopy provides accurate localization and identifies the operative borders and critical anatomical structure of skull base, optic nerve and internal carotid artery, and also clearly indicate their adjacent relations , also decreases surgical invasions and complications. IGNS can improve the accuracy and safety, particularly in local anatomic structure due to the trauma caused by changes in the relationship with the exercise of the adjacent surgery.