Intraoperative computed tomography in otorhinolaryngology
Intraoperative computed tomography in otorhinolaryngology
复制标题
DOI：
10.1080/00016480510040119
复制
发表时间：
2006-01
影响因子：
1.4
通讯作者：
Martin Stieve;Burkard Schwab;C. Haupt;Sotirios Bisdas;R. Heermann;T. Lenarz
中科院分区：
文献类型：
--
作者：
Martin Stieve;Burkard Schwab;C. Haupt;Sotirios Bisdas;R. Heermann;T. Lenarz
结论.术中CT手术为外科医生提供了关于困难解剖情况下手术部位改变的额外信息。颅底和纸样板可以通过术中CT显示，这在涉及困难手术部位的鼻内鼻窦手术中可能是有益的，尽管由于血液伪影无法评估单个筛窦细胞。这为外科医生提供了有价值的信息，可以大大促进手术。在软组织手术中，建议使用造影剂以获得良好的软组织对比度，从而使肿瘤与良性组织充分区分。CT的术中应用是一个相当耗时的过程，部分原因是准备时间（器械设置; 10分钟预热阶段），部分原因是计算每张图像所需的时间长度（15秒）。Objective. CT是一种成熟的成像方法，用于评估头颈部区域的骨和软组织结构。然而，保存信息并将其传输到术中部位可能存在问题。计算机辅助导航系统现在能够辅助耳鼻喉科领域的困难外科手术。为了研究术中CT的适应症，我们将其用于头颈部的各种外科手术。材料和方法。在46例病例中使用Tomoscan M进行术中CT，以证明以下手术的手术受益：鼻窦（上颌窦和筛窦炎，蝶窦前部骨折）的鼻内手术;通过激光手术切除肿瘤（下咽癌和喉癌）;以及人工耳蜗植入（验证电极位置）。将患者定位在CT床上后，将工作站设置在手术室中。如有必要，机架可以在患者头部上方移动，而无需重新定位患者。结果术中CT用于辅助鼻窦内窥镜手术中颅底和纸样板的暴露。由于血液伪影，无法对单个筛窦进行评价。术中成像被证明在慢性鼻窦炎的翻修手术中特别有帮助，因为以前的手术导致解剖标志缺失，颅底或眼眶损伤的风险增加。在颅面切除术中，可以确定切除边缘。在软组织手术中，例如通过激光手术切除肿瘤，已证明可以使恶性肿瘤的切除边界可视化。评估人工耳蜗植入中的电极位置对于翻修病例和人工耳蜗闭塞病例特别有用。
Conclusions. Intraoperative CT surgery provides the surgeon with additional information about the altered surgical site in difficult anatomical situations. The skull base and lamina papyracea may be revealed by means of intraoperative CT, which may be beneficial in endonasal sinus surgery involving difficult surgical sites, although individual ethmoid cells cannot be assessed owing to blood artefacts. This provides the surgeon with valuable information that may facilitate the procedure considerably. In soft-tissue surgery it is advisable to apply a contrast agent in order to achieve good soft-tissue contrast, thus allowing the tumour to be adequately distinguished from benign tissue. The intraoperative application of CT is a fairly time-consuming procedure, partly owing to the preparation time (set-up of the appliance; 10-min warming-up phase) and partly due to the length of time required to calculate each image (15 s). Objective. CT is a well-established imaging method for the assessment of osseous and soft-tissue structures in the head and neck region. Saving information and transferring it to the intraoperative site may, however, be problematic. Computer-assisted navigation systems are now able to assist difficult surgical procedures in the field of otolaryngology. To investigate the indications for intraoperative CT, we used it in various surgical procedures in the head and neck region. Material and methods. Intraoperative CT was applied using the Tomoscan M in 46 cases in order to demonstrate the surgical benefit of the following procedures: endonasal surgical procedures on the paranasal sinuses (maxillary and ethmoidal sinusitis, anterior fracture of the sphenoidal sinus); tumour removal by means of laser surgery (carcinomas of the hypopharynx and larynx); and cochlear implantation (to verify the electrode position). After positioning the patient on the CT table, the workstation was set up in the operating theatre. If necessary, the gantry could be moved over the patient's head without repositioning the patient. Results. Intraoperative CT was used to assist in the exposure of the skull base and lamina papyracea in endonasal surgery of the paranasal sinuses. Individual ethmoidal sinuses could not be evaluated owing to blood artefacts. Intraoperative imaging proved particularly helpful in revision surgery for chronic sinusitis in cases with missing anatomical landmarks owing to previous surgeries, where there is an increased risk of inflicting damage to the skull base or orbita. The resection margins can be determined in craniofacial resections. In soft-tissue procedures, such as tumour removal by means of laser surgery, it proved possible to visualize the resection borders of malignant tumours. Assessment of the electrode position in cochlear implantation is particularly useful in revision cases and in cases of cochlear obliteration.