Application of intraoperative high-field magnetic resonance imaging in pediatric neurosurgery.
Application of intraoperative high-field magnetic resonance imaging in pediatric neurosurgery.
复制标题
术中高场磁共振成像在小儿神经外科中的应用
DOI：
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
M. Hamilton
中科院分区：
文献类型：
--
作者：
Ron Levy;R. Cox;W. Hader;T. Myles;G. Sutherland;M. Hamilton
对象
在过去的十年中，术中MR（iMR）成像在儿科神经外科人群中的使用已越来越被接受为一种创新和重要的神经外科工具。作者总结了他们使用集成神经导航的移动的1.5 T iMR成像单元的经验，目的是确定该技术的应用改变了手术过程或修改了手术策略的手术和/或病理。
方法
已前瞻性维护了该患者人群的数据库。作者审查了数据库中所有患者的医院病历和成像结果。该综述显示，1998年3月至2008年4月期间，在98名儿童（49名男性和49名女性）中进行了105例神经外科手术。由外科医生决定是否获得夹层内（ID）和/或质量保证图像。
结果
手术时的中位年龄为12岁（4个月-18岁）。进行了100例颅内手术和5例脊柱手术;其中22例手术是因为复发性病理学。获得了102例手术的手术计划扫描，93例患者使用了神经导航。iMR成像的最大影响在55例切除肿瘤病变的手术中明显;其中49例手术获得了ID扫描。在49%的手术中进行了进一步的手术，在此期间获得了ID扫描。不同颅骨病理组中较小比例的ID扫描（21例癫痫病例中的5例，9例血管病例中的4例）导致进一步切除，以满足外科医生的手术目标。在5例脊柱疾病治疗手术中获得的两次ID扫描未导致手术发生任何变化。术后扫描未发现任何急性不良事件。有1例术中不良事件，其中Greenberg牵开器在ID扫描期间意外留在原位，但在定位扫描后被移除。
结论
iMR成像在小儿神经外科人群中的应用至少允许进行微创手术暴露。当其高质量成像能力与其上级神经导航能力相结合时，其潜力最大，这允许在手术过程中跟踪颅内肿瘤的切除程度，并在较小程度上跟踪其他病变。
OBJECT
Over the past decade, the use of intraoperative MR (iMR) imaging in the pediatric neurosurgical population has become increasingly accepted as an innovative and important neurosurgical tool. The authors summarize their experience using a mobile 1.5-T iMR imaging unit with integrated neuronavigation with the goal of identifying procedures and/or pathologies in which the application of this technology changed the course of surgery or modified the operative strategy.
METHODS
A database has been prospectively maintained for this patient population. The authors reviewed the hospital charts and imaging results for all patients in the database. This review revealed 105 neurosurgical procedures performed in 98 children (49 male and 49 female) between March 1998 and April 2008. Intradissection (ID) and/or quality assurance images were obtained at the discretion of the surgeon.
RESULTS
The median age at surgery was 12 years (4 months-18 years). One hundred intracranial and 5 spinal procedures were performed; 22 of these procedures were performed for recurrent pathology. Surgical planning scans were obtained for 102 procedures, and neuronavigation was used in 93 patients. The greatest impact of iMR imaging was apparent in the 55 procedures to resect neoplastic lesions; ID scans were obtained in 49 of these procedures. Further surgery was performed in 49% of the procedures during which ID scans had been obtained. A smaller proportion of ID scans in the different cranial pathology groups (5 of 21 epilepsy cases, 4 of 9 vascular cases) resulted in further resections to meet the surgical goal of the surgeon. Two ID scans obtained during 5 procedures for the treatment of spinal disease did not lead to any change in surgery. Postoperative scans did not reveal any acute adverse events. There was 1 intraoperative adverse event in which a Greenberg retractor was inadvertently left on during ID scanning but was removed after the scout scans.
CONCLUSIONS
The application of iMR imaging in the pediatric neurosurgical population allows, at minimum, the opportunity to perform less invasive surgical exposures. Its potential is greatest when its high-quality imaging ability is coupled with its superior neuronavigation capabilities, which permits tracking of the extent of resection of intracranial tumors and, to a lesser extent, other lesions during the surgical procedure.
影响因子：
19.7
作者：
R. Schwartz;L. Hsu;T. Wong;D. Kacher;A. Zamani;P. Black;E. Alexander;P. Stieg;T. Moriarty
通讯作者：
R. Schwartz;L. Hsu;T. Wong;D. Kacher;A. Zamani;P. Black;E. Alexander;P. Stieg;T. Moriarty
影响因子：
4.8
作者：
Black, PM;Moriarty, T;Jolesz, FA
通讯作者：
Jolesz, FA