磁共振导航引导下的无框架立体定向神经外科  

Open MR-guided neurosurgical procedures by using real-time frameless stereotaxis

作　　者：王清河[1] 戴建平[2] 王守江[3] 姜卫剑[2] 张星虎[2] 杜斌[2] 张建国[2] 王忠诚[3] 

机构地区：[1]首都医科大学附属北京天坛医院,博士研究生100050 [2]北京天坛医院 [3]北京市神经外科研究所

出　　处：《中华神经外科杂志》2003年第5期384-387,共4页Chinese Journal of Neurosurgery

摘　　要：目的 开放式磁共振结合导航系统,可以获得准确的手术定位、对手术器械的实时引导和术中监控。本文探讨磁共振导航应用于无框架立体定向神经外科的初步经验、可能的并发症及应用前景。方法 使用Philip公司的0.23T开放式磁共振结合iPath200光学导航系统,对4例脑占位及4例脯脓肿患者分别施行脯活检和脓肿穿刺抽吸术。结果 所有患者均获得穿刺针的准确定位。4例脑活检取得足够的组织样本,术后无并发症出现;4例脑脓肿术后影像资料证实脓肿腔体积缩小50％以上,1例小脑脓肿患者死亡,死亡原因为多器官功能衰竭,其余患者神经功能缺损症状均有不同程度的改善,未发生手术所致并发症。结论 磁共振导航应用于脑活检和脑内囊性病变的穿刺引流,手术成功率高,对患者损伤小。Objective The integration of open-MR and optical navigation system can be used in neurosurgery for accurately lesion positioning, real-time tracing of surgical devices and intraoperative monitoring. We evaluate our preliminary clinical experience with this new technique. Methods An open-design 0.23 T magnet combined with iPath 200 optical navigation system was used for the 8 frameless MR-guided neurosurgical procedures (4 brain biopsys and 4 drainage of brain abscess) . Results In all cases the technique resulted in successful placements of the needles within the target lesions to complete the procedures. Post -procedure MR scan displayed the volumes of 4 abscesses reduced by more than 50%. One of the patients suffered from cerebellar abscess died of multiple organs failure. The clinical manifestations in the other three patients improved evidently without complications induced by procedures, conclusion The MR-guided procedures with high success rate may cause minimal invasive injuries without serious complications.

关 键 词：磁共振导航引导 无框架立体定向神经外科 手术定位 手术器械 实时引导 

分 类 号：R651[医药卫生—外科学] R445.2[医药卫生—临床医学]