耳显微外科和耳神经外科手术中计算机辅助外科技术的应用-东南大学学报医学版

耳显微外科和耳神经外科手术中计算机辅助外科技术的应用

单位：南京医科大学第一附属医院耳鼻咽喉科, 江苏南京 210029

分类号：R764.93

出版年·卷·期（页码）：2012·31·第三期（281-285）

摘要：

目的:初步探讨计算机辅助外科(CAS)技术即导航外科技术在耳显微外科及耳神经外科手术中的应用。方法:选择2例手术患者,分别行经颅中窝(MCF)径路前庭神经雪旺细胞瘤切除术和耳蜗下径路岩尖囊肿引流术,术前计算机编程和确定标记(基准标点),术中应用CAS技术辅助引导手术路径。结果:CAS技术可缩短MCF手术中颞骨解剖定位所需时间。由于将参照弓直接固定于颅骨,在整个手术过程中增加了系统的准确性和稳定性,即使患者偶然移动亦不受影响。当岩尖囊肿位置非常深、耳蜗下气房发育不良时,采用CAS技术非常有帮助。结论:在颞骨外科中CAS技术的主要优势是快速、准确的解剖定向,最重要的是缩短了手术时间和避免了一些并发症,然而CAS技术不能替代经验、解剖知识和外科判断力。

Objective: To explore application of the computer-aided surgery (CAS), namely the surgical navigation technique, in Otomicrosurgery and ear neurosurgery. Methods: 2 cases respectively underwent vestibular nerve schwann cells tumor resection through the middle cranial fossa (MCF) approach and petrous apex cyst treated via subcochlear drainage. Preoperative computer programming and benchmark punctuation along with the application of CAS during the operation could guide the surgical route. Results: CAS reduced the time needed for anatomic localization of the temporal bone. Because the refer bow was directly fixed on the skull, the accuracy and stability of the system were better throughout the whole operating process. Even through patients occasionally move, location accuracy was not affected. If petrous apex cyst is located very deep with mastoid air cell dysplasia, CAS might be very useful for draining by under-cochlear approach. Conclusion: The main advantage of CAS in the temporal bone surgery is rapid and accurate in anatomy orientation, which can shorten operation time and avoid some complications. However, surgery experience, anatomical knowledge and surgical judgment can not be replaced by CAS.

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