影像导航下的鼻内镜手术

目的　通过影像导航下进行的 5 3例鼻内镜手术分析 ,就不同类型耳鼻咽喉影像导航系统在鼻内镜手术中应用的有关问题进行探讨。方法　慢性鼻窦炎、鼻息肉 2 4例 ,鼻咽纤维血管瘤 4例 ,垂体腺瘤 8例 ,鼻窦骨化纤维瘤 9例 ,鼻咽混合瘤 2例 ,鼻腔平滑肌瘤 1例 ,霉菌性鼻窦炎 3例 ,鼻腔内翻性乳头状瘤 2例 ,分别在 3种类型的影像导航系统导航下进行鼻内镜手术。结果　影像导航术前准备时间 15～ 30min ,平均 2 6min。影像标志与实体指示之间误差 <1mm的范围包括鼻窦、颅底等手术区域。其中 3例患者术中出现较明显误差 ,均及时发现。 5 3例均手术过程顺利 ,无术中、术后并发症。手术时间与传统的鼻内镜手术相比无明显差异。结论　不同类型影像导航系统均能与鼻内镜配合 ,但各有优缺点。鼻腔、鼻窦及颅底解剖变异 ,肿物伴眶、颅底侵犯 ,有鼻科手术史解剖标志缺失的患者 ,是进行影像导航手术的指征。导航技术可以帮助医师在手术中确认鼻及颅底的局部及相邻解剖标志 ,提高手术的精确性 ,增加医师的信心 ,在未来鼻 颅底微创外科中有良好应用前景     

本刊第七届编委会新聘编委简介(Ⅲ)

刘钢 (195 9年 8月～ ) ,天津人。 1982年毕业于天津第二医学院医学系 ,师从赵绰然教授 ,现为天津市环湖医院耳鼻咽喉科主任、天津市鼻病诊疗中心主任、副主任医师 ,中华医学会天津市耳鼻咽喉科学会委员。多年来 ,从事耳鼻咽喉科临床实践 ,积累了丰富临床经验。鼻科学造诣深 ,对鼻科、颅底外科疑难重症的诊断和治疗有丰富的临床经验。擅长利用鼻窦内镜开展功能性鼻内镜手术、鼻眼相关外科及颅底外科手术。 2 0 0 1年赴美国佛罗里达ＭｅｄｔｒｏｎｉｃＸｏｍｅｄ实验室进行鼻窦内镜影像导航手术的培训 ,现已利用计算机影像导航技术开展鼻窦内…     

北京大学人民医院第20期鼻内镜微创外科培训班通知

由北京大学人民医院耳鼻咽喉科主办的国家级继续教育项目"第20期鼻内镜微创外科培训班"[No:2013-07-01-027(国)]将于2013年8月8-12日在北京举行。主要培训内容包括鼻腔鼻窦解剖及影像学、鼻内镜外科基本技术及进展、围手术期处理,内镜外科在鼻眼、鼻颅底和鼻腔鼻窦肿瘤方面的应用,鼻-鼻窦     

影像导航引导鼻内镜下切除鼻窦-前颅底骨化纤维瘤

目的:探讨影像导航在经鼻内镜切除鼻窦-前颅底骨化纤维瘤手术中的作用.方法:选择鼻窦-前颅底骨化纤维瘤患者14例,在影像导航引导经鼻内镜下手术切除.术前后均行鼻窦CT连续扫描.CT显示所有病例均累及鼻中隔、眶纸板及筛板.10例累及额隐窝前壁,5例累及眶尖与视神经管,3例累及蝶鞍和斜坡,2例侵犯至翼腭窝.结果:所有患者均彻底切除病灶.平均手术时间280 min,影像导航配准过程平均9 min,重新配准6例.术后复查鼻窦CT均显示病变完整切除.结论:影像导航引导下经鼻内镜手术切除鼻窦-前颅底骨化纤维瘤,有助于彻底切除肿瘤并减少并发症.     

影像导航系统在鼻内窥镜手术中的应用

目的通过28例在影像导航下进行的鼻内窥镜手术,探讨耳鼻咽喉影像导航系统在鼻内窥镜手术中应用的有关问题。方法慢性鼻窦炎、鼻息肉10例,鼻咽血管纤维瘤4例,垂体腺瘤6例,鼻窦骨化纤维瘤3例,鼻咽混合瘤2例,鼻腔平滑肌瘤1例,霉菌性鼻窦炎1例,鼻腔内翻性乳头状瘤1例,均在影像导航系统导航下进行鼻内窥镜手术。结果术前准备时间15～30min,平均26min。配准系数在1.3～2.0之间,平均1.9;影像与实体指示之间误差小于1mm的范围包括鼻窦、颅底等手术区域。28例均手术过程顺利,无术中、术后并发症。手术时间与传统的鼻内窥镜手术相比差异无显著性。结论影像导航系统能与鼻内窥镜配合。鼻腔、鼻窦及颅底解剖变异,肿瘤伴眶、颅底侵犯,有鼻科手术史正常解剖标志缺失的患者,是进行影像导航手术的指征。导航技术可以帮助医师在手术中确认鼻及颅底的局部及相邻解剖,提高手术的精确性,在未来鼻-颅底微创外科中有良好的应用前景。     

北京大学人民医院第21期鼻内镜微创外科培训班通知

由卫生部批准的国家级继续教育项目“第21期鼻内镜微创外科培训班”将于2014年8月21日-8月25日在北京如期举行[项目编号2014—07-01—171（国），国家级继续教育学分8分]。主要培训内容：鼻腔鼻窦解剖及影像学，鼻内镜外科手术操作技巧、围手术期处理，鼻内镜在鼻-鼻窦炎以及鼻眼、鼻颅底和鼻腔鼻窦肿瘤方面的应用，鼻内镜微创外科技术新进展，鼻-鼻窦炎和变应性鼻炎规范诊治，     

磁导航技术在鼻内镜鼻窦手术中的临床应用

目的通过分析磁导航鼻内镜鼻窦手术的临床应用,探讨磁导航在鼻内镜鼻窦手术中的应用价值。方法分析2008年2月~2016年2月复旦大学附属华东医院耳鼻咽喉头颈外科接受磁导航鼻内镜鼻窦手术的239例鼻窦疾病患者的临床资料,同期选取鼻内镜鼻窦手术未使用导航的298例鼻窦疾病患者的临床资料作为对照。比较两组患者的手术时间及手术并发症发生率。结果导航组手术时间明显少于非导航组（P＜0.001）,且导航组眶内血肿发生率及总体并发症发生率均明显低于非导航组（P=0.036和0.002）。结论影像磁导航可显著缩短手术时间,减少手术并发症发生率,提高手术精准性及安全性。导航技术在鼻内镜鼻窦手术中具有较高的应用价值,其常规应用可能会使更多的需要接受内镜鼻窦手术的患者受益。     

影像导航系统在鼻内窥镜手术中的应用

目的 通过28例影像导航下进行的鼻内窥镜手术,探讨耳鼻咽喉影像导航系统在鼻内窥镜手术中的应用的有关问题。方法 慢性鼻突炎、鼻息肉10例,鼻咽血管纤维瘤4例,垂体腺瘤6例,鼻窦骨化纤维瘤3例,鼻咽混合瘤2例,鼻腔平滑肌瘤1例,霉菌笥鼻窦炎1例,鼻腔内翻性乳头状瘤1例,均在影像导航系统导航下进行鼻内窥镜手术。结果 术前准备时间15－30min,平均26min。配准系数在1.3-2.0之间,平均1.9;影像与实体指示之间误差小于1mm的范围包括算窦、颅底等手术区域。28例均手术过程顺利,无术中、要后并发症。手术时间与传统的鼻内窥镜手术相比差异无显著性。结论 影像导航系统能与鼻内窥镜配合。鼻腔、鼻窦及颅底解剖变异,肿瘤伴眶、颅底侵犯,有鼻科手术史正常解剖标志缺失的患者,是进行影像导航手术的指征。导航技术可以帮助医师在手术中确认鼻及颅底的局部及相邻解剖,提高手术 的精确性,在未来鼻－颅底微创外科中有良好的应用前景。     

北京大学人民医院第二十一期鼻内镜微创外科培训班通知

由卫生部批准的国家级继续教育项目“第二十一期鼻内镜微创外科培训班”将于2014年8月21-25日在北京如期举行【项目编号2014-07-01-171（国），国家级继续教育学分8分】。主要培训内容：鼻腔鼻窦解剖及影像学，鼻内镜外科手术操作技巧、围手术期处理，鼻内镜在鼻．鼻窦炎以及鼻眼、鼻颅底和鼻腔鼻窦肿瘤方面的应用，鼻内镜微创外科技术新进展，鼻一鼻窦炎和变应性鼻炎规范诊治。培训班由国内知名专家专题讲座，一对—尸头解剖训练，手术示教等。     

北京大学人民医院第20期鼻内镜微创外科培训班通知

由北京大学人民医院耳鼻咽喉科主办的国家级继续教育项目"第20期鼻内镜微创外科培训班"[No:2013-07-01-027(国)]将于2013年8月8-12日在北京举行。主要培训内容包括鼻腔鼻窦解剖及影像学、鼻内镜外科基本技术及进展、围手术期处理,内镜外科在鼻眼、鼻颅底和鼻腔鼻窦肿瘤方面的应用,鼻-鼻窦炎和变应性鼻炎的规范诊治,一对一尸头解剖训练,手术示教等。届时还将邀请多位国内知名专家进行专题讲座。此培训项目已连续举办19期,深受好评,欢迎有一定鼻内镜外科基础的同道参加。学习期满合格     

Intraoperative Navigation mit Fokus auf der Schädelbasis

Intraoperative navigation systems are widely used in ENT, oral and maxillofacial, and neurosurgery. The benefits of such systems have been demonstrated in various applications, including intracranial and skull base surgery. Intraoperative shift, “brain shift” and changes in anatomy caused by the surgical procedure itself impair the accuracy of navigation and represent factors limiting its application, particularly in glioma and metastatic brain surgery. For this reason, intraoperative imaging was incorporated into neurosurgery. A specific application of navigation is thus skull base surgery, where shifts are often negligible due to the bony structures in which pathologies are embedded. Development of new systems with seamless integration into the operative workflow propagated routine use of navigation in neuro- and ENT surgery. Navigation proved especially helpful in interdisciplinary surgery with pathologies located in anatomic regions where competences of different surgical disciplines overlap, as in the skull base. While this increased radicality in tumour resection, there was a high risk of morbidity. The integration of electrophysiological function monitoring served to preserve function and reduce morbidity, and has led to less invasive and radical strategies in skull base surgery. New radiosurgical methods to adjuvantly treat possible tumour remnants have also supported this development. Systems allowing resection borders to be marked in the navigational coordinates would enable direct linking of these data to radiotherapy planning and better interpretation of follow-up imaging. Navigation is thus a valuable tool supporting interdisciplinary cooperation in skull base surgery for the benefit of patients.     

Three-dimensional computed tomography angiography of the internal carotid artery for preoperative evaluation of sinonasal lesions and intraoperative surgical navigation

INTRODUCTION: Three-dimensional computed tomographic angiography (3DCTA) demonstrates the spatial relationships of the internal carotid artery (ICA) and adjacent skull base. This imaging modality may be incorporated into intraoperative surgical navigation during endoscopic skull base surgery. METHODS: The charts of patients who had undergone 3DCTA imaging between July 2002 and February 2005 were reviewed. For 3DCTA, 1 mm axial computed tomography (CT) scan images were obtained with simultaneous intravenous contrast bolus on a multidetector CT scanner (Somatom Sensation 16, Siemens, Munich, Germany). The CBYON Suite version 2.6 to 2.8 (Med-Surgical Services, Mountain View, CA) was also used for creating CTA images through its volume-rendering protocols. RESULTS: A total of 22 3DCTA studies were performed for diagnostic evaluation or preoperative planning. In 18 instances, the 3DCTA images were used during intraoperative surgical navigation. The specific indications for obtaining the 3DCTA study included neoplasm (11 cases), cerebrospinal fluid leak (3 cases), fibro-osseous lesion (2 cases), mucocele (2 cases), and other (4 cases). Images generated by 3DCTA facilitated the definition of the anatomic relationships between the ICA and skull base lesion. During intraoperative surgical navigation, the 3DCTA provided critical information about the ICA location and adjacent skull base anatomy in the operative field. CONCLUSIONS: 3DCTA is a useful means for assessing the ICA and its relationship to skull base lesions. Incorporation of 3DCTA into intraoperative surgical navigation facilitates the comprehension of operative field anatomy in the ICA region. As a result, this imaging technique, especially when combined with intraoperative surgical navigation, may extend the applications of minimally invasive endoscopic approaches to the skull base.     

Imaging in cochlear implant patients

Imaging procedures are a mainstream tool in the daily ENT workflow. Cochlear Implant patients are representing a special population with specific demands for imaging. There are different imaging techniques available for pre-operative evaluation, surgery and postoperative controls with different indications and consequences. High-resolution computed tomography and magnetic resonance imaging are mainly used in the evaluation process. New procedures, as digital volume tomography, are increasingly used intra- and postoperatively. Especially the intracochlear positioning in malformations of the inner ear, eventually added with radiological assisted navigation, can be considered a standard of modern cochlear implant surgery. In addition, digital volume tomography may serve as a quality control tool focusing on the evaluation of the intracochlear electrode position. The range of applications, indications and current results are illustrated.     

Cone Beam computerized tomography and implants

The authors, both working as radiologist in private practice, have initiated the Cone Beam technique as soon as 1999 and report their own experience. Cone Beam Computerized Tomography (CBCT) is dedicated to hard tissues imaging thus specifically adapted to oral implantology and maxillofacial surgery. It has the advantage to deliver low dose radiation, compared to other techniques. CBCT permits anatomical volume acquisition. After data analysis on computer, distances and implants 3D simulation can be checked. CBCT differs from CT scan because it is more adapted to hard tissues, it has a better resolution than CT, and because it delivers lower doses. Its isotropic pixel particularity which gives exact linear measurements, and the fact that metallic artifacts are significatively diminished, gives CBCT its high interest in implantology. These advantages of CBCT and the small place needed for its installation explain its global wide spreading. CBCT is now considered to be the gold standard in dental and maxillofacial sectional imaging. Because of its biomeasuring capacity, its bi- and tridimensional reconstruction possibilities, its surgical navigation and simulation capacity, it is now widely used in implantology.     

Navigation-supported surgery in the head and neck region

Few of the pioneering manufacturers who attempted to develop navigation systems have been able to establish themselves within the market long-term. The same applies to the technological basis of these systems which aid intraoperative anatomical orientation. The first few systems registered the mechanical displacement of the navigational instrument's axes. Optoelectronic and electromagnetic methods are now prevalent. In contrast to electromagnetic systems, the "line of sight" between the camera system, the reference markers placed on the patient's head and the navigation instruments must remain unobstructed during the navigation process when using electrooptical navigation systems. Whereas, in the past, only preoperative CT scans were used for navigation, the integration of MRI and sonography--whose images can now be fused with each other and with those provided by other intraoperative imaging techniques such as fluoroscopy and endosonography--has become increasingly popular. Navigation systems require input of information about spatial conditions. This is carried out via procedures of registration and referencing, by means of which the relative position of reference markers at the head of the patient is correlated with the image data. The equipment is calibrated in the same way. Headsets, headbands and bone-anchored adapters are available for the fixation of the markers in the patient's head. Whereas the use of a headband or headset requires considerably less time, bone-anchored referencing increases the precision of the navigation system. The surgeon must be able to manage the different methods. In order to reduce the time required for preoperative preparation and to enhance the handling of the navigation processor for the surgeon, it is essential to have a clear menu. The surgeon is able to plan the steps involved in the surgery using the processor, define the access to the surgical site and control the surgery intraoperatively. Preoperative segmentation of functionally and clinically relevant structures enables minimally invasive surgery to be carried out, such as procedures with the aim of acquiring biopsy tissue and the search for foreign bodies. Following the technical development of the systems, the manufacturers are endeavouring to simplify their handling in close coordination with the users. The next step has to be the clinical evaluation of the navigation systems in accordance with the EBM standard, in order to establish this assistive method as routine clinical practice while applying meaningful medical criteria.     

Intraoperative surgical navigation for endoscopic sinus surgery: rationale and indications

PURPOSE OF REVIEW: The present review discusses the rationale and indications for image-guided surgery through a critical discussion of registration concepts as well as clinical reports. RECENT FINDINGS: The surgical navigation accuracy achieved by commercially available image-guided surgery systems is best reported as target registration error. Clinically achievable target registration error is probably in the 1.5-2.0 mm range. Dry lab studies of registration serve to highlight the principles of registration, the process through which image-guided surgery systems calculate the one-to-one mapping relationship between the preoperative imaging data and the intraoperative surgical volume. Reports on image-guided surgery have highlighted its usefulness in primary and revision endoscopic sinus surgery, osteoplastic frontal sinusotomy, transsphenoidal hypophysectomy, endoscopic cerebrospinal fluid leak repair and endoscopic pterygomaxillary fossa biopsy. Both three-dimensional computed tomography angiography and computed tomography-magnetic resonance fusion images have been incorporated into IGS for advanced minimally invasive endoscopic skull base procedures. The American Academy of Otolaryngology-Head and Neck Surgery policy statement accurately summarizes the current consensus for image-guided surgery applications. SUMMARY: Image-guided surgery has emerged as an important technology, which both general otolaryngologists and subspecialty rhinologists can employ for a wide variety of procedures.     

Endoscopic Skull Base Surgery

Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field.     

Iontophoretic treatment of oral herpes

Recent development of pharmaceutical agents that interfere with reproduction and metabolism of the herpes virus appear to have clinical applications in the treatment of orocutaneous herpetic lesions. Use of topical medications has always been limited by skin penetration. Combining these new pharmaceutical agents with iontotransport techniques has been shown to be effective for treatment of herpetic lesions. Instrumentation and a specially designed applicator electrode are described. Use of this instrumentation and its clinical application is described in the treatment of 32 patients and the results are summarized. Combining the use of the new pharmaceuticals with the iontotransport instrumentation is described as an effective treatment of localized herpetic lesions. Similar technique offers fascinating possibilities in other areas of skin pathology.     

Update in der navigiert kontrollierten und mechatronisch assistierten Kopf-Hals-Chirurgie in Deutschland

A consequence of the ongoing advances in medical navigation is the development of so-called mechatronic assistant systems. Up to now, medical navigation had been used only for additional intrasurgical orientation. But improvements in accuracy in imaging and medical navigation can exceed the surgeon's possible manual accuracy of surgical manipulation. In such cases, mechatronic assistant systems can supplement certain surgical procedures in order to obtain the required precision, such as for positioning of implants. The development and possible use of such mechatronic assistant systems in the head and neck, as well as improvements in the accuracy of medical navigation, are the focus of several working groups. For coordinating and adapting the various research projects, different research groups were called to present their current projects and results in the context of ASKRA (working group for skull-base and craniofacial surgery of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery) workshops at the German Society for Computer- and Robot-Assisted Surgery (CURAC) convention on 14 October 2006 in Hanover. Different projects were presented, with topics including navigated controlled assistant systems for the frontal and lateral skull base, possibilities for sonographic-induced bone measurement, and requirements for high-precision surgery of the skull base.     

Functional magnetic resonance imaging: contemporary and future use

PURPOSE OF REVIEW: Functional magnetic resonance imaging is a relatively new neuroimaging technique that is being used in both research and clinical applications. Increasing work has been done to elucidate the auditory cortex. RECENT FINDINGS: Current studies focus on enhancing the sensitivity of functional magnetic resonance imaging in studying the auditory cortex and subcortical pathways in response to tonal stimulation, to evaluate the integrity of the auditory cortex before cochlear implantation, and as a screening tool for hearing impairment in the young child. SUMMARY: Recent work has been encouraging: silent functional magnetic resonance imaging techniques allow for better evaluation of the auditory cortex with less confounding scanner noises. Functional magnetic resonance imaging can be safely and reproducibly performed in hearing-impaired children and in the preoperative evaluation of candidates for cochlear implantation.