机器人辅助立体定向脑脓肿穿刺抽吸术的临床应用研究(附4例报告)

doi:10.19854/j.cnki.1008-2425.2022.06.0010

摘要/Abstract

摘要： 目的探讨机器人辅助无框架立体定向穿刺抽吸技术治疗脑脓肿的微创手术方法及治疗效果。方法回顾性分析4例采用机器人辅助立体定向穿刺抽吸术治疗脑脓肿患者的临床资料,分析手术疗效、并发症发生率。结果机器人辅助立体定向设备可精准引导脑脓肿穿刺,4例患者无手术死亡病例,术后脓肿腔平均持续引流时间为1.2天,拔管后复查头颅CT提示脓肿腔显著缩小,占位效应明显减轻。所有患者神经症状得到不同程度改善。结论对于脑脓肿患者, 机器人辅助立体定向穿刺抽吸术是一种及时、安全且有效的治疗方法,能够更好的改善神经功能,提高患者远期生活质量。尤其对于高龄,脓肿位置深等不适合开颅的患者,扩大了手术适应症的范围。

关键词: 脑脓肿, 立体定向, 机器人辅助, 无框架, 疗效

中图分类号:

R742.7

倪升远, 张旺, 鲍得俊. 机器人辅助立体定向脑脓肿穿刺抽吸术的临床应用研究(附4例报告)[J]. 立体定向和功能性神经外科杂志, 2022, 35(6): 370-373.

参考文献

[1] Asquier-Khati A,Deschanvres C,Boutoille D,et al.Switch from parenteral to oral antibiotics for brain abscesses:a retrospective cohort study of 109 patients[J].J Antimicrob Chemother,2020,75(10):3062~3066.
[2] Cantiera M,Tattevin P,Sonneville R.Brain abscess in immunocompetent adult patients[J].Rev Neurol (Paris),2019,175(7-8):469~474.
[3] Cardinale F,Rizzi M,d'Orio P,et al.A new tool for touch-free patient registration for robot-assisted intracranial surgery:application accuracy from a phantom study and a retrospective surgical series[J].Neurosurg Focus,2017,42:E8.
[4] Sonneville R,Ruimy R,Benzonana N,et al.An update on bacterial brain abscess in immunocompetent patients[J].Clin Microbiol Infect,2017,23(9):614~620.
[5] Air EL,Leach JL,Warnick RE,et al.Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain:a retrospective review of 284 cases[J].J Neurosurg,2009,111:820~824.
[6] Balossier A,Blond S,Reyns N.Endoscopic versus stereotactic procedure for pineal tumor biopsies:focus on overall efficacy rate[J].World Neurosurg,2016,92:223~228.
[7] Faria C,Erlhagen W,Rito M,et al.Review of robotic technology for stereotactic neurosurgery[J].IEEE Rev Biomed Eng,2015,8:125~137.
[8] Kwoh YS,Hou J,Jonckheere EA,et al.A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery[J].IEEE Trans Biomed Eng,1988,35(2):153~160.
[9] Fomenko A,Serletis D.Robotic stereotaxy in cranial neurosurgery:a qualitative systematic review[J].Neurosurgery,2018,83(4):642~650.
[10] Lu Y,Yeung C,Radmanesh A,et al.Comparative effectiveness of frame-based,frameless,and intraoperative magnetic resonance imaging-guided brain biopsy techniques[J].World Neurosurg,2015,83:261-8.
[11] Bradac O,Steklacova A,Nebrenska K,et al.Accuracy of VarioGuide frameless stereotactic system against framebased stereotaxy:prospective,randomized,single-center study[J].World Neurosurg,2017,104:831~840.
[12] Woodworth GF,McGirt MJ,Samdani A,et al.Frameless image-guided stereotactic brain biopsy procedure:diagnostic yield,surgical morbidity,and comparison with the frame-based technique[J].J Neurosurg,2006,104:233~237.
[13] Wang X,Li L,Luo P,et al.Neuronavigation-assisted trajectory planning for deep brain biopsy with susceptibility-weighted imaging[J].Acta Neurochir,2016,158:1355~1362[14] Tsermoulas G,Mukerji N,Borah AJ,et al.Factors affecting diagnostic yield in needle biopsy for brain lesions[J].Br J Neurosurg,2013,27:207~211.
[15] Bjartmarz H,Rehncrona S.Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation[J].Stereotact Funct Neurosurg,2007,85(5):235~242.
[16] Philipp LR,Matias CM,Thalheimer S,et al.Robot-assisted stereotaxy reduces target error:a metaanalysis and meta-regression of 6056 trajectories[J].Neurosurgery,2021 Jan 13;88(2):222~233.
[17] Widmann G,Schullian P,Ortler M,et al.Frameless stereotactic targeting devices:technical features,targeting errors and clinical results[J].Int J Med Robot,2012,8(1):1~16.
[18] Neudorfer C,Hunsche S,Hellmich M,et al.Comparative study of robot-assisted versus conventional frame-based deep brain stimulation stereotactic neurosurgery[J].Stereotact Funct Neurosurg,2018,96(5):327~334.
[19] De Benedictis A,Trezza A,Carai A,et al.Robot-assisted procedures in pediatric neurosurgery[J].Neurosurg Focus,2017,E7:10.3171.
[20] Minchev G,Kronreif G,Martínez-Moreno M,et al.A novel miniature robotic guidance device for stereotactic neurosurgical interventions:preliminary experience with the iSYS1 robot[J].J Neurosurg,2016,126:1~12.
[21] Coca HA,Cebula H,Benmekhbi M,et al.Diffuse intrinsic pontine gliomas in children:interest of robotic frameless assisted biopsy[J].A technical note.Neurochirurgie,2016,62(6):327~331.
[22] Marcus HJ,Seneci CA,Payne CJ,et al.Robotics in keyhole transcranial endoscope-assisted microsurgery:a critical review of existing systems and proposed specifications for new robotic platforms[J].Neurosurgery,2014,10(Suppl 1):84~95.