电磁导航技术在鼻颅底手术中的应用

Application of electromagnetic navigation system in nasal skull base surgeryZHANG Junjie1, MA Shiyin2, LI Hui2, WANG Xiaomin2 , ZHANG Mingjie2, CHEN Deshang2

摘要:

摘要：目的探讨电磁导航技术在鼻颅底手术中的临床应用。方法收集 2017 年 8月—2019 年 2月应用电磁导航技术行 15例鼻颅底手术，患者病变范围涉及蝶窦、鞍区、咽旁隙、颈静脉孔区、筛顶、蝶骨平台等解剖区域。术前均完善 CT、MRI 等影像学资料，录入导航系统行三维重建，鼻内镜下进行手术，涉及复杂、重要解剖结构时使用导航系统进行定位。结果15例手术中1例鼻颅底纤维血管瘤术中出血约1 000 ml，余手术出血均可控。15例手术术中均未出现重要结构损伤，术后无严重并发症。15 例患者术后随访3~20个月，1例鼻颅底腺样囊性癌患者术后12个月复查考虑肿瘤复发。结论电磁导航技术应用于鼻颅底手术中，安全、精准，手术并发症少，特别适用于解剖结果变异、修正鼻内镜手术、病变广泛的恶性肿瘤患者。

Abstract:

Abstract:ObjectiveTo explore the clinical application of electromagnetic navigation system in nasal skull base surgery.MethodsFrom Aug 2017 to Feb 2019, 15 patients undertook nasal skull base surgery in our department using magnetic navigation system. The surgical lesions included sphenoid sinus, sella area, parapharyngeal space, jugular vein foramen area, ethmoidal roof, sphenoid plateau and others. The preoperative computerized tomography (CT), magnetic resonance imaging (MRI) were performed, and the data were imported into the navigation system for threedimensional (3D) reconstruction. All the surgical procedures were performed under nasal endoscope, and the electromagnetic navigation system was adopted for positioning when the complex, important anatomical structures were involved.ResultsThe intraoperative bleeding was controllable except hemorrhage of about 1000 ml in one case of nasalskull fibroangioma. None of the 15 cases had significant structural damage or serious complications. They were followed up for 3 to 20 months postoperatively, and tumor recurrence was suspected in one of nasal skull base adenoid cystic carcinoma at 12 months after operation.ConclusionWith advantages of high safety and accuracy as well as few surgical complications, the electromagnetic navigation system is suitable for the surgical procedures of nasal skull base, especially those with anatomical variations, revision endoscopic sinus surgery, and malignant tumors with extensive lesions.