新一代CR型脑外科机器人在颅内病变活组织检查中的应用探讨

Application of the new CR neurosurgical robot system in the biopsy of intracranial lesions

目的评估应用新一代CR型脑外科机器人进行颅内病变立体定向穿刺活组织检查(简称活检)的安全性和准确性。方法回顾性分析2018年10月至2020年6月于航天中心医院神经外科行颅内病变活检的60例患者的临床资料。术前1~2 d行头颅增强MRI T1加权成像三维磁化强度预备梯度回波序列扫描,手术当日行螺旋CT薄层扫描。将CT、MRI数据导入新一代CR型脑外科机器人手术计划系统,进行CT-MRI融合定位,计算穿刺靶点的坐标,并根据病灶的部位和神经影像学特征,设计个体化穿刺路径后进行活检。术后评估靶点定位的准确性,并观察术后并发症的发生情况。结果60例患者均成功实施无框架立体定向穿刺活检。术后病理学结果为:弥漫性星形细胞瘤和少突胶质细胞肿瘤25例,神经元和混合性神经元-胶质肿瘤1例;淋巴瘤16例;转移性肿瘤4例;炎性肉芽肿2例;脑内血管瘤1例;炎性脱髓鞘病变6例;急性淋巴细胞白血病颅内浸润1例;精原细胞细胞瘤1例;原始神经外胚层肿瘤1例;朗格汉斯细胞组织细胞增生症1例;血管炎性疾病1例;诊断阳性率为100%(60/60)。术后靶点准确性评估结果显示,60例患者的靶点误差为(1.36±0.42)mm(0.55~1.99 mm)。术后发生穿刺相关性出血2例,经治疗后好转;1例接受脑干活检的患者术后出现一侧面瘫,经保守治疗后好转。结论应用新一代CR型脑外科机器人可根据颅内病变的形态进行手术规划,具有创伤小、定位精度高、操作灵活、简便等优点,适用于颅内各部位病变的活检。

Objective To evaluate the safety and accuracy of stereotaxic biopsy of intracranial lesions using the new CR neurosurgical robot system.Methods A retrospective analysis was conducted on the clinical data of 60 patients who underwent intracranial lesion biopsy in the Neurosurgery Department of Aerospace Central Hospital from October 2018 to June 2020.Three-dimensional,T1-weighted magnetization-prepared gradient-echo imaging was performed 1 to 2 days before surgery.Spiral CT thin-slice scanning was performed on the day of surgery.CT and MRI data were imported into the new CR neurosurgery robot operation planning system,CT-MRI fusion and positioning were performed,the coordinates of the puncture target were calculated,and an individualized puncture trajectory was designed according to the location of the lesion and neuroimaging characteristics,which was followed by tissue biopsy.The accuracy of target localization was evaluated postoperatively,and postoperative complications were documented.Results All 60 patients underwent successful frameless stereotaxic biopsy.Postoperative pathological results were as follows:25 cases of diffuse astrocytic and oligodendroglial tumor,1 case of neuronal and mixed neuronal-glial tumors,16 cases of lymphoma,4 cases of metastatic tumor,2 cases of inflammatory granuloma,1 case of haemangioma,6 case of inflammatory demyelination,1 case of acute lymphoblastic leukemia with intracranial infiltration,1 case of seminoma,1 case of primitive neuroectodermal tumor,1 case of Langerhans cell histiocytosis and 1 case of the central nervous system vasculitis.The positive rate of diagnosis was 100%(60/60).The results of postoperative target accuracy evaluation showed that the target error of 60 patients was 1.36±0.42 mm(0.55-1.99 mm).Postoperative puncture-related bleeding occurred in 2 cases,which improved after treatment;1 patient who received brainstem biopsy developed unilateral facial palsy after operation,which improved after conservative treatment.Conclusions The new CR brain surgery robot can carry out surgical planning according to the shape of intracranial lesions.It has the advantages of less trauma,high positioning accuracy,flexible and simple operation,etc.It is suitable for biopsy of intracranial lesions at multiple sites.