机械臂立体定向系统引导下锁孔手术

微侵袭手术是神经外科手术发展方向之一 ,由于机械臂立体定向系统的应用 ,为小切口锁孔开颅切除颅内小病变 ,提供了很好的技术保证。我院和北京航空航天大学共同研制开发的新一代机械臂立体定向系统 (CAS R Ⅲ型 ) ,经我院几年的临床研制和应用 ,具有准确的立体定向定位能力和灵活易操作的技术性能。现就用该系统定位下行锁孔开颅切除颅内小病变的临床应用报告如下 :资料与方法1.资料　本组病灶的选择 ,均经头颅CT或MR检查确诊 ,病灶大小在 2cm以内 ,距脑表面至少2cm以下的脑组织内 ,这些病变用常规开颅手术很难或较难找到。共计 9人 ,…     

脑立体定向手术治疗精神分裂症的追踪观察

脑立体定向手术治疗精神分裂症的追踪观察李思特岳文浩李秋香单飞豹为了解手术治疗精神分裂症的远期疗效和对此进行综合评价，我们对接受过该手术治疗的病人进行了追踪观察。１．资料和方法：试验组为２７例接受过双侧扣带回、杏仁核立体定向手术的、符合中国精神疾病分类...     

立体定向手术治疗507例震颤麻痹的经验

本文介绍５０７例震颤麻痹采用立体定向手术治疗的经验，手术有效率由早期８２．３％上升达９５￣９８％，并发症由１５．７％降至５％以下，死亡率由１．０８％降至０．２９％，对本病手术治疗的要求，病例的选择、双侧手术适应证和减少并发症等进行了讨论。     

计算机立体定向技术的临床应用研究

目的应用计算机技术与立体定向技术的结合,提高定向手术的准确性、安全性和实用性,扩大了其临床应用范围.方法采用"BH”系列机器人定向系统及计算机立体定向设备,以CT为引导方法,全部选择各种原因不能接受开颅手术的病人,进行各种不同方式的定向手术.结果顺利成功地开展了51例64次定向手术,无合并症、无手术死亡、手术成功率100%,术后近期症状好转率达100%,病理诊断符合率在95%以上.结论计算机立体定向手术系统设计合理,可操作性强,图象处理清晰,靶点选择精确,三维坐标数据可靠,手术过程简单方便,省时省力,安全性高,合并症少,具有非常广泛的临床应用价值.     

凝血酶治疗脑立体定向活检术中出血初步探讨

脑立体定向手术非直视下操作，术中可能损伤深部脑血管而致颅内出血，特别是小动脉出血，处理困难，本文报告凝血酶脑内局部灌注治疗定向术中出血１０例，包括动脉出血２例，控制出血快速有效，无并发症，尽管凝血酶用量过多可造成脑血管痉挛和脑梗塞，但只要用量适当则可有效止血，挽救生命，故局部灌注适量凝血酶的方法是可取的。     

CT脑立体定向显微直视手术切除脑功能区及深部病变

ＣＴ脑立体定向显微直视手术切除脑功能区及深部病变张剑宁章翔易声禹杨桂兰李安民梁景文近年来脑立体定向技术的应用范围日益扩大，将此技术与显微神经外科手术相结合，用于切除脑功能区及脑深部小病灶，可使手术精确性明显提高，手术附加损伤很少，属微侵袭神经外科范畴...     

机器人辅助无框架脑立体定向手术

目的应用机器人取代传统的定向仪框架,施行脑立体定向手术。方法计算机体层摄影（ＣＴ）／磁共振成像（ＭＲＩ）扫描定位,计算机建立与靶点对应的三维坐标体系,智能机械臂按照手术规划为术提供导航和操作平台。结果临床成功完成无框架定位手术８０例,无手术并发症,近期手术有效率９２．５％。结论此方法与普通立体定向手术比较,具有减轻病人痛苦、扩大手术范围、方便术操作提高手术安全性等优点。     

手术机器人在神经外科的应用及发展

随着计算机技术、航天工程技术的进步,外科手术机器人也逐渐从实验研究走向临床实际.自20世纪80年代起,一些发达国家投入大量财力、物力、人力用于研发手术机器人,其中最为成功的应属Intuitive Surgical公司研发的da Vinci手术机器人系统.该系统于1999年1月获得欧盟安全认证(CE认证),2000年7月通过美国食品药品管理局(FDA)认证,目前已在普通外科、泌尿外科、妇科、心胸外科等领域得到了广泛的应用,并取得了巨大的成功[1-2].     

Stent-graft use in endovascular neurosurgery

The authors describe 2 clinical observations of the use of stent-grafts (polymer film-covered stents) in endovascular neurosurgery. In one case, a stent-graft was used to perform a reparative endovascular operation for the carotid-cavernous fistula; in the other the vertebral artery was stented at the origin of an afferent vessel of arteriovenous malformation of the spinal cord. The prospects for using endovascular prostheses in the surgery of extra- and intracranial vessels are discussed.     

精准神经外科：高科技时代的神经外科新理念

神经外科是医学中最年轻同时也是最复杂的一门学科,由于脑功能的复杂性和重要性,要求神经外科手术必须定位准确,操作精细。早在1917年,现代神经外科的奠基人,HarveyCushing教授就提出＂神     

Stereotactic neurosurgery in children and adolescents

Between March 1992 and January 1998, 100 stereotactic procedures were carried out in our Stereotactic Department. Of these, 24 were performed on patients under 18 years of age, 22 of them under a local anaesthetic and sedation. The ages of these patients ranged between 4 months and 18 years. The stereotactic procedures carried out were: 15 cerebral biopsies, 5 iodine-125 implants, 4 implantations of Rickham reservoirs with ventricular catheter, with additional holes to establish a connection between the cyst content and the ventricular system (internal drainage): 2 of these patients had arachnoidal cysts in the pineal region, 1 a thalamic neuroepithelial cyst and 1 a cystic craniopharyngioma, with excellent control of hydrocephalus. All cerebral biopsies were positive, including 3 in which brain stem tumours were detected. Of the 5 patients treated by brachytherapy, 4 had pilocytic astrocytomas and 1 an anaplastic astrocytoma. The sites of the tumours for which implants were used were the thalamus in 4 cases, and the basal ganglia (corpus striatum) in 1. In only 2 cases was there some transistory morbidity, and mortality was nil. The stereotactic procedures in this varied group were well tolerated, with low morbidity and mortality rates, which proves that this method is effective and safe for patients. It can also be used for the diagnosis of brain stem tumours. Midline cysts can also be treated by means of internal drainage with catheters (a minimally invasive form of surgery). Received: 6 November 1998     

脑转移瘤患者单纯手术治疗与手术联合术后脑部放疗对比分析

目的 总结脑转移瘤单纯手术和手术联合术后脑部放疗的治疗经验,并筛查此类患者放疗获益的相关影响因素.方法 纳入北京协和医院脑转移瘤数据库中2011年1月1日至2018年12月31日的成人脑转移瘤患者141例,根据不同治疗方案分为单纯手术组(91例)和手术联合术后脑部放疗组(联合治疗组,50例),收集性别、年龄、脑转移瘤数...     

虚拟现实技术量化经额入路显露海绵窦区显微解剖研究

目的利用Dextroseope虚拟现实系统定量评价经额人路显露海绵窦区的显微解剖特点。方法根据尸头CT和MRI影像数据,以Dextroscope虚拟现实系统构建海绵窦三维解剖模型,分别选择颅盖和颅底标识点连成三角形模拟手术骨窗和海绵窦不同显露术野(三角面A、B、c)。结果不同术野三角形面积比较,B面术野最大(均P=0.000).但是到达术野前的操作空间和经过脑组织的体积A、B、c三面之间差异无统计学意义(P>0.05)。经C面术野到达海绵窦前所需磨除前床突和显露颈内动脉及其分支的体积,分别大于经B面和经A面术野(均P=0.000);经B面术野进入海绵窦后磨除前床突的体积,以及显露脑神经和颈内动脉的体积分别大于经C面和A面术野(均P=0.000);经A面术野与经B面术野进入海绵窦后显露垂体的体积差异无统计学意义(P>0.05);经C面术野不显露垂体。结论虚拟现实技术模拟经额显露海绵窦显微手术入路具有快捷、直观、量化、可重复等优势。     

虚拟现实技术量化经额入路显露海绵窦区显微解剖研究

目的利用Dextroscope虚拟现实系统定量评价经额入路显露海绵窦区的显微解剖特点。方法根据尸头CT和MRI影像数据,以Dextroscope虚拟现实系统构建海绵窦三维解剖模型,分别选择颅盖和颅底标识点连成三角形模拟手术骨窗和海绵窦不同显露术野（三角面A、B、c）。结果不同术野三角形面积比较,B面术野最大（均P=0．000）,但是到达术野前的操作空间和经过脑组织的体积A、B、C三面之间差异无统计学意义（P〉0．05）。经C面术野到达海绵窦前所需磨除前床突和显露颈内动脉及其分支的体积,分别大于经B面和经A面术野（均P=0．000）;经B面术野进入海绵窦后磨除前床突的体积,以及显露脑神经和颈内动脉的体积分别大于经c面和A面术野（均P=0．000）;经A面术野与经B面术野进入海绵窦后显露垂体的体积差异无统计学意义（P〉0．05）;经c面术野不显露垂体。结论虚拟现实技术模拟经额显露海绵窦显微手术人路具有快捷、直观、量化、可重复等优势。     

Adaptive training of cortical feature maps for a robot sensorimotor controller

This work investigates self-organising cortical feature maps (SOFMs) based upon the Kohonen Self-Organising Map (SOM) but implemented with spiking neural networks. In future work, the feature maps are intended as the basis for a sensorimotor controller for an autonomous humanoid robot. Traditional SOM methods require some modifications to be useful for autonomous robotic applications. Ideally the map training process should be self-regulating and not require predefined training files or the usual SOM parameter reduction schedules. It would also be desirable if the organised map had some flexibility to accommodate new information whilst preserving previous learnt patterns. Here methods are described which have been used to develop a cortical motor map training system which goes some way towards addressing these issues. The work is presented under the general term ‘Adaptive Plasticity’ and the main contribution is the development of a ‘plasticity resource’ (PR) which is modelled as a global parameter which expresses the rate of map development and is related directly to learning on the afferent (input) connections. The PR is used to control map training in place of a traditional learning rate parameter. In conjunction with the PR, random generation of inputs from a set of exemplar patterns is used rather than predefined datasets and enables maps to be trained without deciding in advance how much data is required. An added benefit of the PR is that, unlike a traditional learning rate, it can increase as well as decrease in response to the demands of the input and so allows the map to accommodate new information when the inputs are changed during training.