神经导航术中脑移位的研究

Intraoperative brain shift in neuronavigator -guided surgery

目的定量研究不同神经导航手术中的脑移位,评价术中脑移位对神经导航手术定位准确性的影响。方法在73例颅脑手术中应用StealthStation神经导航系统指导手术操作,制作骨瓣前在骨窗外作对照参考点,然后分别测量硬膜、皮层和病灶移位程度,并分别对不同病理性质肿瘤的移位情况进行分析。结果平均注册误差(2.13±0.74)mm,术中持续准确性为(1.17±0.67)mm;所有73例的硬膜、皮层和病灶移位程度分别为(2.80±2.48)mm、(5.14±4.05)mm以及(3.53±3.67)mm。胶质瘤组的硬膜、皮层和病灶移位均是最大的,而海绵状血管瘤组以及颅底肿瘤组的移位明显低于胶质瘤组。结论术中脑移位是影响神经导航手术定位准确性的重要因素,对不同性质和部位病变术中脑移位的了解有助于指导手术操作。

Objective A quantitative analysis of intraoperative brain shift in neuronavigator-guided surgery was performed to evaluate the impact of brain shift on accuracy of neuronavigation.Method The measurements of the dura,cortical surface,and lesion margin were recorded respectively,after correlation points(sustained accuracy)were performed around bone flap in seventy-three StealthStation neuronavigator-guided surgeries.Result In all73cases,the shifts of the dura,cortical surface,and lesion margin were(2.80±2.48)mm,(5.14±4.05)mm,and(3.53±3.67)mm,respectively,when mean fiducial error and the displacement of correlation points were(2.13±0.74)mm and(1.17±0.67)mm,respectively.The shifts of the dura,cortical surface,and lesion margin were significantly higher in gliomas than in both cavernous angiomas and skull base tumors.Conclu sion Intraoperative brain shift plays an important role in the loss of spatial accuracy in neuronavigator-guided surgery.The understanding of intraoperative brain-shift of the lesions in different location and pathology during surgery was very helpful to guide the surgical interventions.