影像导航在前中颅底手术中的应用

目的探讨应用影像导航技术施行前、中颅底的手术，避免损伤颅底周围重要的神经血管组织，降低手术并发症，提高手术疗效。方法在影像导航下共施行前中颅底手术112例，其中外伤性视神经管骨折19例；脑脊液鼻漏15例；中颅底肿瘤26例（骨纤维异常增殖症3例、翼腭窝中颅底鳞状细胞癌6例、鞍旁神经纤维瘤1例、后筛窦颅底骨瘤4例、垂体瘤12例）；累及颅内的蝶窦囊肿17例；霉菌性蝶窦炎11例；孤立性蝶窦炎18例；后组筛窦、蝶窦炎鼻息肉6例。结果112例患者在影像导航的引导下，顺利找到骨折、漏口、或者窦口位置；确定肿瘤边界，精准确定周围重要结构的位置，避免损伤；顺利准确地进行配准。结论影像导航技术在前中颅底外科手术中的应用有定位准确、标志清楚、降低手术并发症、最大限度地切除病变等优点，可以弥补鼻内窥镜下操作缺乏层次感的局限。影像导航的基础是手术前的影像，不能反映手术中的变化，而配准精确是导航手术的关键所在，一旦对应关系破坏将出现严重后果，手术中要定时检查配准情况。

Application of an image guidance system in anterior and middle skull base operations

Objective To discuss the value of an image guidance system in anterior skull base operations, and its assistance in avoiding damage to important nerves and vessels of the cranial fossa, lowering the rate of surgical complications and raising the curative rate. Methods We performed 112 operations with the help of an image guidance system, which included operations on 19 patients with traumatic fractures of optic canals, 15 with cerebrospinal rhinorrhea, 26 with tumors of the middle skull base （ 3 with fibrous dysplasia, 6 with squamous cell carcinoma of the sphenomaxillary fossa and middle skull base, 1 with metasellar neurofibroma, 4 with ostoma of the posterior-iethmoid and skull base and 12 with hypophysoma）, 17 with sphenoid sinus cysts involving the intracranial structure, 11 with mycotc sphenoiditis, 18 with isolated sphenoiditis, and 6 with posterior-iethmoiditis, sphenoiditis and nasal polyps. Results The image guidance system was well configured in all 112 patients and with its help we could find the fracture, ventage or apertures, and the boundary in patients with tumors, and we could also locate the surrounding vital structures thus avoiding harming them. Conclusions The image guidance system can help us accurately and clearly locate the destination and lower the rate of surgical complications, excise the pathological tissues to the maximum extent, and compensate for the lack of 3 dimension location of nasal endoscopes. But the image guidance system is setup on preoperative images and can not reflect changes in surgery. Accurate configuration is the key to the image guidance system and if the correspond- ing position is damaged, catastrophic results maybe occurs, so it is important to check the system regularly.