Résumé
BACKGROUND@#Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.@*METHODS@#Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons' comfortability.@*RESULTS@#A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).@*CONCLUSIONS@#The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.
Résumé
Objective To explore the applied value of high-field intraoperative magnetic resonance imaging (iMRI) in multi-image fusion guided stereotactic brain biopsy.Methods Twenty-four patients with intracranial lesions were examined by conventional MRI and diffusion tensor imaging (DTI) with 1.5T iMRI system before operation in our hospital from June 2011 to April 2012.The digital image data and preoperative PET/CT image data were transferred into BrainLAB planning workstation and all kinds of images were automatically fused.We used the BrainLAB software to reconstruct the corticospinal tract (CST) and three-dimensional display the anatomic relationship of CST and brain lesions.Leksell surgical planning workstation was used to help to choose the best target site and the reasonable needle track.The 1.5T iMRI was used to effectively monitor the intracranial condition during brain biopsy procedure.Results Needle biopsies were successfully performed in all 24 patients and pathological diagnosis was explicitly obtained in 23 patients,leading to a diagnostic yield of 95.8％.No patient suffered from significant complications during or after surgery.Conclusions With the help of high-field iMRI,multi-image fusion guided stereotactic brain biopsy conduces to achieving the purpose of higher positive rate of biopsy and lower incidence of complications.The method with this design combining MRI-DTI fusion images with the frame-based stereotactic biopsy can play a significant role in intracranial lesions of deep functional areas.
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Objective To discuss the etiological relationship between brain trauma and glioma.Methods A case of post-traumatic glioblastoma was reported with regard to his clinical manifestations,imaging features and pathological characteristics, and the related literatures were present. Results This case is consistent with the criteria on the glioblastoma mutiforme following cerebral trauma in literatures.Conclusion The development of a brain tumour following a cortical injury is possible, although rare. The presupposition for the development of a glioma following brain trauma is a predisposing genetic alteration of brain cells.