影像导航系统在复杂鼻颅底内镜手术中的应用

目的 评价影像导航系统在复杂鼻颅底内镜手术中的作用。方法 26例中额窦复发性内翻性乳头状瘤2例，鼻腔鼻窦肿瘤侵及颅底5例，垂体腺瘤7例，创伤性视神经病12例，均应用影像导航系统行鼻内镜手术。结果 影像导航术前准备时间(包括配准、头架定位、常规器械注册等) 5～10min, 平均7min。手术区域影像标志与实体解剖标志间的误差≤1. 5mm，手术均顺利完成,术中、术后未出现并发症。结论 导航系统定位准确, 能帮助术者确定术区周围重要解剖结构，可以实时判定肿瘤切除程度, 能够最大限度地切除肿瘤, 减少并发症。尤其在有既往手术史或病变破坏了鼻鼻窦及颅底解剖标志的情况下,导航系统对术者的帮助更大，增强了术者自信心,提高了手术的安全因素，保证了肿瘤切除的彻底性。

Application of an image guidance system in complex endoscopic endo-nasal skull base surgery

To evaluate the effectiveness of an image-guided navigation system (IGNS) in complex endoscopic sino-nasal and anterior skull base surgery. Methods26 patients who underwent image-guided endoscopic surgery were involved in this study, including 2 patients with recurred frontal sinus inverted papilloma, 5 with nasal cavity and sinuses neoplasms that extended to the skull base, 7 with pituitary adenomas and 12 with traumatic diseases of the optic nerve. ResultsPreparation of intra-operative imaging guided navigation system (including registering, head rest positioning, and surgical instruments registration ) needed 5～10min (mean 7min). The localization error of image landmarks was less than 1.5mm to the entity anatomic landmarks. All operative procedures were successfully performed without any intra-operative or post-operative complications. ConclusionsIGNS provides accurate anatomical localization, it can help the operator to make certain the locations of important anatomic structures in the operative region and to decide the excision extent for neoplasm in real time, so as to remove the neoplasm to the utmost extent and decrease the occurrence of complications. IGNS reinforces the self-confidence of the operators and enhances security of the operation, especially when the patient has a history of operation or anatomic landmarks of the skull base are destroyed by sino-nasal disease.