RESUMO
Application of a novel technique is analyzed. Frameless CT-based navigation was applied for planning of surgical approach in 92 patients aged 14 to 69 with acute intracranial hemorrhage of different etiology (43 cases of hypertensive hemorrhages, 10 cases of traumatic intracranial hematomas and 16 cases of secondary non-traumatic intracerebral hematomas). Comparative analysis of radioopaque markers and natural anatomical landmarks for registration of patients showed that anatomical landmarks are sufficient for surgical planning without significant distortion of approach trajectory (mean error was 2.2 +/- 1 mm) in supratentorial haemorrhage. This discovery simplified the application of neuronavigation in emergency cases. In posterior fossa hematomas additional radioopaque markers are essential due to absence of constant anatomical landmarks in occipital region. Applicatyion of frameless neuronavigation in surgical treatment of acute intracranial hemorrhages may diminish intraoperative damage to the brain tissue and decrease invasiveness of the operation because of high accuracy of planning of surgical approach. This technique has good perspectives in emergency neurosurgery.
Assuntos
Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/cirurgia , Neuronavegação/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Serviço Hospitalar de Emergência , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/mortalidade , Radiografia , Resultado do Tratamento , Adulto JovemRESUMO
The application of CT-navigation in emergency neurosurgery for the calculation of surgery assets in 42 patients with hypertensive intracranial hemorrhages is presented. The relative simplicity and high precision of navigation (on average 2,2 +/- 1 mm) made it possible to use the method in emergency surgery of deep intracranial hematomas. The application of CT navigation in combination with neuroendoscopy and local fibrinolysis of hemorrhages allowed to decrease the post-surgery brain trauma and reduce the volume of intervention due to the high precision of calculation that resulted in the improvement of surgical outcome. The total post-operative mortality was 24%. In 94% of survived patients positive changes in neurological status were observed in 2-4 weeks after the surgery.
