无框架机器人引导立体定向活组织检查术在儿童脑干肿瘤中的应用  

Application of frameless robot-assisted stereotactic biopsy in children with brainstem tumors

作　　者：王敏 张毅 施伟 诸壬卿 李昊 赵瑞 Wang Min;Zhang Yi;Shi Wei;Zhu Renqing;Li Hao;Zhao Rui(Department of Neurosurgery,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院神经外科,国家儿童医学中心,上海201102

出　　处：《中华神经外科杂志》2022年第7期664-668,共5页Chinese Journal of Neurosurgery

基　　金：复旦大学附属儿科医院产学研高新技术转化孵化项目(FDEKCXY10)。

摘　　要：目的探讨无框架机器人引导的立体定向活组织检查术(简称活检)在儿童脑干肿瘤中的应用价值。方法回顾性分析2018年6月至2021年4月在复旦大学附属儿科医院神经外科行无框架机器人引导的立体定向脑干肿瘤活检术患儿的临床资料,共35例。术前行CT薄层扫描及增强MRI检查,将CT及MRI数据输入SinoPlan手术计划系统,根据病灶位置及神经影像学特征,设计个体化的穿刺路径。安装Mayfield头架,利用SINO手术机器人根据手术计划系统规划靶点及路径坐标获取脑组织。进行组织病理学和分子基因检测。结果35例患儿均经立体定向活检术后获得确诊,术后病理学结果:星形细胞瘤1例(2.9%),弥漫性中线胶质瘤34例(97.1%)(其中31例伴有H3K27M突变)。手术时长为(79.1±25.7)min(38~121 min),术后住院时长为(6.7±2.1)d(4~15 d)。术后6 h复查CT显示5例(14.3%)患儿有少量脑出血,但无相关临床症状;患儿均未发生术中及术后大出血、新发神经功能缺损及手术相关死亡事件。结论无框架机器人引导立体定向脑干肿瘤活检术创伤小、操作简便、并发症少、定位准确、取材成功率高。Objective To explore the application value of frameless robot-assisted stereotactic biopsy in pediatric brainstem tumors.Methods A retrospective study was conducted on the clinical data of 35 children who underwent frameless robot-guided stereotactic brainstem tumor biopsy in the Department of Neurosurgery,Children′s Hospital of Fudan University from June 2018 to April 2021.Preoperative CT thin-section scan and enhanced MRI examination were performed,and the CT and MRI data were input into the SinoPlan surgical planning system,and an individualized puncture path was designed according to the location of the lesion and neuroimaging characteristics.The Mayfield head frame was installed,and the SINO surgical robot was used to plan the target and path coordinates to obtain brain tissue according to the surgical planning system,followed by histopathology and molecular genetic testing.Results Established diagnoses were made in all 35 children after stereotactic biopsy.Postoperative pathological results included 1 case(2.9%)of astrocytoma and 34 cases(97.1%)of diffuse midline glioma(31 cases with H3K27M mutation).The operation time was 79.1±25.7 min(38-121 min),and the postoperative hospital stay was 6.7±2.1 d(4-15 d).The re-examination of head CT 6 hours after operation showed that 5 cases(14.3%)had a small amount of cerebral hemorrhage without related clinical symptoms.No major hemorrhage occurred during or after operation,and there was no new neurological deficit or operation-related death.Conclusion The frameless robot-assisted stereotactic brainstem tumor biopsy has the advantages of accurate positioning,high success rate of sampling,less trauma,simple operation,and low incidence of surgery-related complications.

关 键 词：脑干肿瘤 儿童 活组织检查 针吸 机器人 立体定向 

分 类 号：R739.41[医药卫生—肿瘤]