术中CT导航在先天性颅颈畸形腹侧减压中的应用  

Intraoperative computed tomography with integrated navigation decompression of congenital craniovertebral junction malformation

作　　者：余新光[1] 李连峰[1] 王鹏[1] 周定标[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《中华神经外科杂志》2012年第6期559-563,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（30973032）

摘　　要：目的探讨术中CT与导航系统在先天性颅颈交界区畸形腹侧减压手术中的应用价值。方法先天性颅颈交界区畸形患者19例，其中男11例，女8例，年龄13～58岁，平均33．9岁，患者术中行cT扫描，根据重建结果制定个性化的腹侧减压方案，术中在导航引导下实施手术，术中验证减压效果，根据Nurick分级评价随访结果。结果术中CT及导航系统应用顺利，验证准确度平均为1．6mm（1．2～2．0mm）。其中4例患者术中第一次CT验证显示减压不充分，进一步磨除残留骨质后，再次术中cT验证均获得满意的减压效果，术中无神经、血管损伤等手术相关并发症发生。术后3个月根据Nurick分级，其中15例较术前至少改善1级，4例患者症状较术前无明显改善。结论术中CT扫描结合导航系统不仅提高了手术成功率，也减少了术中并发症的发生。Objective To assess the feasibility and potential utility of intraoperative computed tomography（iCT）with integrated neuronavigation system （NNS） in individualized decompressive procedure of complex craniovertebral junction malformation （CVJM）. Methods We reported our first 19 complex CVJM cases including 11 male and 8 female patients （mean age, 33.9 y; age range, 13 to 58 y）. A sliding gantry 40 - slice CT scanner was installed in a preexisting operating room. Image data was transferred directly from the scanner into the NNS using an automated registration system. We applied this technology to transoral odontoidectomy in 17 patients. Moreover, with the extra help of iCT integrated with NNS, odontoidectomy through posterior midline approach, and transoral atlantal lateral mass resection were, for the first time, performed for treatment of complex CVJM. Results Of the 19 cases, assessment of iCT scans obtained in 4 indicated further bone removal was required. The results revealed that the goal of osseous resection had been met. Neuronavigation was found to correlate well with the intra - operative findings and the recalibration was uneventful in all cases and had an accuracy of 1.6mm （ 1.2 - 2.0mm）. All patients were clinically evaluated by Nurick grade criteria, and neurological deficits were monitored after 3 months of surgery. Fifteen patients were improved by at least 1 Nurick grade, whereas the grade did not change in 4 patients . Conclusions iCT with integrated NNS was found both feasible and beneficial in the surgical management of complex CVJM. In this unusual patient population, the technique appeared to be valuable in negotiating complex anatomy and achieving a safe and predictable decompression.

关 键 词：术中CT 导航系统 颅颈交界区畸形 齿状突磨除 

分 类 号：R651.1[医药卫生—外科学]