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     Sustained accuracy including SA1(k-wire),SA2(after craniotomy ),SA3(after lesion removal )were(2.4±0.8)mm,(1.3±0.8)mm and(1.5±1.0)mm,re-spectively.
     术中持续准确性SA1(重装参考环后复核K-wire)、SA2(制成骨窗后复核骨窗周围再注册点)、SA3(切除病灶后复核骨窗周围再注册点)依此为(2.4±0.8),(1.3±0.8)和(1.5±1.0)mm。
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Objective To analyse the cause of brain shifting and to resolve it through neuronavigation in micro neurosurgery.Methods The stealthstation system (a modern frameless neuronavigation system)produced by Sofamor Danek Company was used in this study.The pre operative plan and intra operative navigation were rigorously processed according to the criteria of neuronavigation.The occurence of brain shifting was recorded,analyzed and resolved.Results The stealthstation neuronavigation system was used in 150 cases...

Objective To analyse the cause of brain shifting and to resolve it through neuronavigation in micro neurosurgery.Methods The stealthstation system (a modern frameless neuronavigation system)produced by Sofamor Danek Company was used in this study.The pre operative plan and intra operative navigation were rigorously processed according to the criteria of neuronavigation.The occurence of brain shifting was recorded,analyzed and resolved.Results The stealthstation neuronavigation system was used in 150 cases from Nouember 1999 to December 2000,and brain shifting happened in 16 cases (10.7%).Among them,10 cases (62.5%) were systemic brain shifting,6 cases (37.5%) were structural brain shifting.9 cases (56.3%) of systemic brain shifting were resolued,and the others (43.7%) were not resolved.Conclusions The systemic brain shifting can be preveted through rigorous neuronavigative procedure.Once this kind of brain shifting happened,it could be resolved by re align or adding more landmarks.Structural brain shifting could be avoided by decreasing CSF flowing out and brain resected volume.Once happend,it could be corrected by image compensation offered from 3 D ultrasonography intraoperative CT and open MR.

目的 总结应用手术导航系统的经验 ,分析术中影像漂移的原因 ,并提出避免及解决此问题的方法。方法 本研究应用美国SofamorDanek公司生产的StealthStation手术导航系统 ,按一定的导航操作规范进行术前计划及术中导航 ,记录、分析并解决所发生的影像漂移现象。结果  1999年 11月~ 2 0 0 0年 12月完成导航下显微神经外科手术 15 0例 ,观察到影像漂移共 16例 (10 .7% ) ,其中 10例为系统性影像漂移 (6 2 .5 % ) ,6例为结构性影像漂移 (37.5 % ) ;10例中 9例系统性影像漂移得到纠正 (5 6 .3% ) ,另外 1例及 6例结构性影像漂移 (43.7% )未能得到满意解决。结论 对于系统性影像漂移 ,可通过严格导航及手术操作 ,选择最佳注册点来避免 ,一旦发生可通过导航系统的Re align功能纠正 ,或通过头面部体表标志的增加注册加以解决 ;而对于结构性影像漂移 ,可通过减少脑脊液流失、减少脑组织的切除体积、避免肿瘤囊液的过早释放来预防 ,一旦发生 ,则需依靠三维超声、术中CT扫描及开放式磁共振技术做影像补偿才能解决

AIM:To study protective effects of the mi crosurgery on intracranial minute occupying space lesions under the di rection of the neuronavigation system and its accuracy.METHODS:StealthStation neuronavigation sy stem was used to direct the microsurgical incision for 26cases with intracranial minute occupying space lesions and fiducial accuracy,intr aoperative accuracy,intraoperati ve brain shift,operative effect and complic ations were analyzed.RESULTS:Mean fiducial error(MFE)and predicted accuracy at 10cm(PA)were(2.6±0.9)mm...

AIM:To study protective effects of the mi crosurgery on intracranial minute occupying space lesions under the di rection of the neuronavigation system and its accuracy.METHODS:StealthStation neuronavigation sy stem was used to direct the microsurgical incision for 26cases with intracranial minute occupying space lesions and fiducial accuracy,intr aoperative accuracy,intraoperati ve brain shift,operative effect and complic ations were analyzed.RESULTS:Mean fiducial error(MFE)and predicted accuracy at 10cm(PA)were(2.6±0.9)mm and(2.5±0.8)mm,respectively.Sustained accuracy including SA1(k-wire),SA2(after craniotomy ),SA3(after lesion removal )were(2.4±0.8)mm,(1.3±0.8)mm and(1.5±1.0)mm,re-spectively.SA2and SA3to monitor in traoperative accuracy had no obviou s difference(t=0.353,P>0.05).Intraoperative brain shift was(1.5±0.4)mm.The rate of total resection was 100%.Clinical manifestation was improved in 21cases and unchanged in5cases after operation,and there were no operative complications and death.

目的:探讨应用神经外科导航系统指导显微切除颅内微小占位病变的精确性和脑保护作用。方法:应用StealthStation神经外科导航系统指导显微切除颅内微小占位病变26例,对其注册准确性、术中准确性、术中脑移位、手术效果和手术并发症进行分析。结果:平均坐标误差(meanfiducialerror,MFE)、10cm预期准确性(predictedaccuracyat10cm,PA)分别为(2.6±0.9)mm和(2.5±0.8)mm。术中持续准确性SA1(重装参考环后复核K-wire)、SA2(制成骨窗后复核骨窗周围再注册点)、SA3(切除病灶后复核骨窗周围再注册点)依此为(2.4±0.8),(1.3±0.8)和(1.5±1.0)mm。SA2和SA3用于术中准确性的监测,经配对t检验差异无显著性意义(t=0.353,P>0.05)。术中脑移位为(1.5±0.4)mm。手术全切率100%。21例患者术后临床症状改善,5例无变化,无手术并发症及死亡。结论:神经外科导航系统指导显微切除颅内微小占位病变定位及手术准确性高,对脑组织微侵扰。有助于顺利寻找和全切病灶,保护脑功能区,减少手术并发症。

 
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