立体定向手术计划系统在神经外科手术中的可行性及效率性

Feasibility and efficiency of employment of stereotactic surgical planning system in neurosurgery

目的探讨立体定向手术计划系统（SSPS）在神经外科手术中的可行性及效率性。方法回顾性分析2008年3月至2013年1月山东大学第二医院神经外科收治的因功能神经外科疾病拟行立体定向手术患者的临床资料。2010年1月前以有框架MRI为依据行人工设计及测算靶点（简称人工计算组，72例），此后将无框架MRI与有框架CT的数据输入SSPS后完成手术设计（简称SSPS组，153例）。统计SSPS前后因无法获得清晰的MRI影像而不能进行手术的发生率；比较多靶点坐标经SSPS和人工计算的时间；记录SSPS以远程模式进行手术的例数。结果SSPS采用前无法获得清晰的MRI影像而不能进行手术的发生率（简称失手术率）为12．5％（9／72），SSPS采用后失手术率为2．0％（3／153），经比较差异有统计学意义（P=0．003）；在多靶点设定时，SSPS组设定完成时间平均为（8．00±2．75）min，人工计算组平均为（39．98±5．14）min，两组比较差异有统计学意义（P〈0．001）；采用SSPS后以远程模式完成立体定向手术26例，此情况在以往将被取消或推迟手术。结论SSPS能够降低失手术率、减少多靶点的计算时间以及可以远程设计手术，从而提高了立体定向神经外科手术的可行性及效率性。

Objective To investigate the feasibility and efficiency of stereotactic surgical planning system （SSPS） in neurological surgery. Methods This study retrospectively analyzed the data of stereotactic surgeries for functional neurological disorders performed at Department of Neurosurgery, the Second Hospital of Shandong University, from March 2008 to January 2013. Stereotactic surgery guided by SSPS started in January 2010 and before that the fame-based MRI images had been used to manually determine the targets for surgery. Since clear MR data were necessary for the operations, the proportions of patients who acquired clear MR data before and after the application of SSPS were compared. The generation time of coordinates of multiple targets assisted by SSPS was compared with that of manual calculation. The number of SSPS-aided stereotactic neurological surgeries was documented in remote pattern. Results The ratio of unclear MR images was 12.5% （9/72） without SSPS and 2.0% （3/153） with SSPS. The difference was statistically significant （ P = 0. 003 ）. The generation time of coordinates of multiple targets assisted by SSPS was （8.00 ± 2.75 ） minutes, which was much shorter than that in manual work （ 39.98±5. 14） minutes （P 〈 0.001 ）. With SSPS, 26 cases received remote surgical planning at SSPS laptop workstation, for which the operations would have been canceled or postponed without SSPS. Conclusions With SSPS, the ratio of acquiring unclear MR images and the coordinate generation time of multiple targets could both be reduced, and the operations could be performed in remote pattern, which suggests that SSPS may help improve the feasibility and efficiency of stereotactic neurological surgeries.