导航下显微神经外科手术影像漂移的分析

Analysis of brain shifting in micro-neurosurgery with neuronavigation

目的 总结应用手术导航系统的经验 ,分析术中影像漂移的原因 ,并提出避免及解决此问题的方法。方法 本研究应用美国SofamorDanek公司生产的StealthStation手术导航系统 ,按一定的导航操作规范进行术前计划及术中导航 ,记录、分析并解决所发生的影像漂移现象。结果 1999年 11月～ 2 0 0 0年 12月完成导航下显微神经外科手术 15 0例 ,观察到影像漂移共 16例 (10 .7% ) ,其中 10例为系统性影像漂移 (6 2 .5 % ) ,6例为结构性影像漂移 (37.5 % ) ;10例中 9例系统性影像漂移得到纠正 (5 6 .3% ) ,另外 1例及 6例结构性影像漂移 (43.7% )未能得到满意解决。结论 对于系统性影像漂移 ,可通过严格导航及手术操作 ,选择最佳注册点来避免 ,一旦发生可通过导航系统的Re align功能纠正 ,或通过头面部体表标志的增加注册加以解决 ;而对于结构性影像漂移 ,可通过减少脑脊液流失、减少脑组织的切除体积、避免肿瘤囊液的过早释放来预防 ,一旦发生 ,则需依靠三维超声。

Objective To analyse the cause of brain shifting and to resolve it through neuronavigation in micro neurosurgery.Methods The stealthstation system (a modern frameless neuronavigation system)produced by Sofamor Danek Company was used in this study.The pre operative plan and intra operative navigation were rigorously processed according to the criteria of neuronavigation.The occurence of brain shifting was recorded,analyzed and resolved.Results The stealthstation neuronavigation system was used in 150 cases from Nouember 1999 to December 2000,and brain shifting happened in 16 cases (10.7%).Among them,10 cases (62.5%) were systemic brain shifting,6 cases (37.5%) were structural brain shifting.9 cases (56.3%) of systemic brain shifting were resolued,and the others (43.7%) were not resolved.Conclusions The systemic brain shifting can be preveted through rigorous neuronavigative procedure.Once this kind of brain shifting happened,it could be resolved by re align or adding more landmarks.Structural brain shifting could be avoided by decreasing CSF flowing out and brain resected volume.Once happend,it could be corrected by image compensation offered from 3 D ultrasonography intraoperative CT and open MR.