导航辅助内镜下经蝶窦垂体外科的解剖学研究

目的评价导航系统在内镜下经蝶窦垂体手术中的应用。方法在20例尸头标本上模拟内镜下经蝶手术,其中采用GE-Insta Trak 3500电磁导航辅助和无导航辅助各10例。对重要解剖标志及结构变异进行测量与统计,对导航系统精确性进行评估,对导航及非导航辅助下手术的效率与安全性进行比较。结果 GE电磁导航系统误差为(0.28±0.06)mm,实际操作误差为(1.5±0.5)mm。导航系统安装启动平均时间为(11.9±2.0)min。在无解剖变异时导航与非导航辅助下手术时间无统计学差异;若存在解剖变异,前者手术用时较后者明显缩短。结论导航系统辅助内镜经蝶窦手术,在解剖变异、多次手术等解剖关系不明确的病例中,可起到迅速、精确的定位作用,使手术更加安全、高效。

Anatomical study of endoscopic transsphenoidal pituitary surgery assisted by navigation

Objectives To assess the application of navigation system in endoscopic transsphenoidal pituitary surgery.Methods Endoscopic transsphenoidal surgery was performed on 20 head cadavers including 10 assisted with GE-InstaTrak 3500 electromagnetic navigation and 10 without navigation.The important anatomical landmarks and structure variants were measured and analyzed statistically in order to assess the system accuracy.Surgical outcome and security were compared between surgeries assisted with and without navigation.Results The systematic error of GE electromagnetic navigation was 0.28 ±0.06 mm and the actual procedural error was 1.5±0.5 mm.The average time for installing and setting up the navigation system was 11.9±2.0 min.In normal anatomical condition,there was no statistical difference in the operation time between surgeries assisted with and without navigation.When anatomical variations existed,the operation time was significantly shortened by a navigation system.Conclusions The endoscopic transsphenoidal pituitary surgery via navigation system can provide fast and precise localization in the cases with undefined anatomical relationships such as anatomical variations and post multiple surgeries,and make the surgery safer and more efficient.