ROSA机器人在神经外科手术中初步应用体会
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摘要
目的总结ROSA机器人在神经外科手术中的初步应用体会。方法回顾性分析山东省千佛山医院神经外科自2018年9月至10月行ROSA机器人手术的14例患者的临床资料,病种包括脑出血、脑干出血、帕金森病、颅内肿瘤及脑积水等,均有精准靶点的需求,均采用ROSA机器人辅助手术,术后分别评估其应用ROSA手术机器人的可行性、注册方式以及最终治疗靶点的准确度。结果 3例脑出血穿刺引流患者采用面部激光扫描注册,平均误差0.8 mm;1例脑干出血穿刺引流患者采用头皮Mark注册,误差1.0 mm;2例复发胶质瘤射频热凝术患者以及3例脑深部海绵状血管瘤切除患者采用面部激光扫描注册,平均误差0.7 mm;2例颅内病变活检患者与2例脑室腹腔分流术患者采用骨性Mark注册,平均误差0.3 mm;1例脑深部电刺激术患者,采用骨性Mark注册,误差0.3 mm。本组患者术后均达到预期治疗效果,无严重并发症发生。结论 ROSA机器人显著提高神经外科手术精准度和安全性,适应症广,且操作简易,在神经外科手术中应用有广泛的前景。
Objective To summarize ROSA robot's preliminary application experience in neurosurgery. Methods A retrospective analysis was made of 14 patients who underwent ROSA robotic surgery in Department of Neurosurgery, Affiliated Qianfoshan Hospital of Shandong University from September 2018 to October 2018. The types of diseases include cerebral hemorrhage, brainstem hemorrhage, Parkinson's disease, intracranial tumors and hydrocephalus, which all have the need for precise targets. ROSA robotic assisted surgery was used to evaluate the feasibility, registration method and final outcome of ROSA robotic surgery. Results Three cases of cerebral hemorrhage puncture drainage were registered by facial laser scanning with an average error of 0.8 mm; 1 case of brainstem hemorrhage puncture drainage was registered by scalp Mark with an error of 1.0 mm; 2 cases of recurrent glioma undergoing radiofrequency thermocoagulation and 3 cases of deep cerebral cavernous hemangioma resection were registered by facial laser scanning with an average error of 0.7 mm; 2 cases of intracranial lesion biopsy and 2 cases of ventricular abdominal cavity were registered by bone mark with an average error of 0.3 mm; 1 case of Parkinson's disease undergoing deep brain stimulation was registered with skeletal Mark with an error of 0.3 mm. All patients achieved the expected therapeutic effect after operation, and no serious complications occurred. Conclusion ROSA can significantly improve the precision and safety of neurosurgery, has a wide range of indications, and is easy to operate,so it has a broad prospect of application in neurosurgery.
Objective To summarize ROSA robot's preliminary application experience in neurosurgery. Methods A retrospective analysis was made of 14 patients who underwent ROSA robotic surgery in Department of Neurosurgery, Affiliated Qianfoshan Hospital of Shandong University from September 2018 to October 2018. The types of diseases include cerebral hemorrhage, brainstem hemorrhage, Parkinson's disease, intracranial tumors and hydrocephalus, which all have the need for precise targets. ROSA robotic assisted surgery was used to evaluate the feasibility, registration method and final outcome of ROSA robotic surgery. Results Three cases of cerebral hemorrhage puncture drainage were registered by facial laser scanning with an average error of 0.8 mm; 1 case of brainstem hemorrhage puncture drainage was registered by scalp Mark with an error of 1.0 mm; 2 cases of recurrent glioma undergoing radiofrequency thermocoagulation and 3 cases of deep cerebral cavernous hemangioma resection were registered by facial laser scanning with an average error of 0.7 mm; 2 cases of intracranial lesion biopsy and 2 cases of ventricular abdominal cavity were registered by bone mark with an average error of 0.3 mm; 1 case of Parkinson's disease undergoing deep brain stimulation was registered with skeletal Mark with an error of 0.3 mm. All patients achieved the expected therapeutic effect after operation, and no serious complications occurred. Conclusion ROSA can significantly improve the precision and safety of neurosurgery, has a wide range of indications, and is easy to operate,so it has a broad prospect of application in neurosurgery.
引文
[1]梁国标,陶英群.功能神经外科精准时代的助推器---ROSA手术机器人[J].中国微侵袭神经外科杂志,2017,22(2):49-50.
[2]Lefranc M,Capel C,Pruvot AS,et al.The impact of the reference imaging modality,registration method and intraoperative flatpanel computed tomography on the accuracy of the ROSA?Stereotactic robot[J].Stereotact Funct Neurosurg,2014,92(4):242-250.
[3]孙霄,陶英群,许峰,等.ROSA辅助治疗高血压脑出血的优越性及可行性研究[J].中国微侵袭神经外科杂志,2017,22(2):51-53
[4]De Benedictis A,Trezza A,Carai A,et al.Robot-assisted procedures in pediatric neurosurgery[J].Neurosurg Focus,2017,42(5):E7.
[5]孙霄,陶英群,金海,等.ROSA与立体定向框架辅助手术治疗高血压脑出血的对比研究[J].中华神经外科杂志,2018,34(7):674-677.
[6]Vadera S,Chan A,Lo T,et al.Frameless stereotactic robotassisted subthalamic nucleus deep brain stimulation:case report[J].World Neurosurg,2017,97:762.e11-762.e14.
[7]Lefranc M,Capel C,Pruvot-Occean AS,et al.Frameless robotic stereotactic biopsies:a consecutive series of 100 cases[J].JNeurosurg,2015,122(2):342-352.
[8]Brandmeir N,Acharya V,Sather M.Robot assisted stereotactic laser ablation for a radiosurgery resistant hypothalamic hamartoma[J].Cureus,2016,8(4):e581.
[9]Mert A,Kiesel B,W觟hrer A,et al.Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas[J].Neurosurg Focus,2015,38(1):E4
[10]Widmann G,Schullian P,Ortler M,et al.Frameless stereotactic targeting devices:technical features,targeting errors and clinical results[J].Int J Med Robot,2012,8:1-16.
[11]Curry DJ,Gowda A,McNichols RJ,et al.MR-guided stereotactic laser ablation of epileptogenic foci in children[J].Epilepsy Behav,2012,24(4):408-414.
[12]Smith TR,Mithal DS,Stadler JA,et al.Impact of fiducial arrangement and registration sequence on target accuracy using a phantom frameless stereotactic navigation model[J].J Clin Neurosci,2014,21(11):1976-1980.
[13]Kristin J,Mucha D,Schipper J,et al.Registration strategies for the application of the navigation system Fiagon at the lateral scull base[J].Laryngorhinootologie,2012,91(5):306-310.
[14]Zhou C,Anschuetz L,Weder S,et al.Surface matching for highaccuracy registration of the lateral skull base[J].Int J Comput Assist Radiol Surg,2016,11(11):2097-2103.
[15]詹启敏.健康中国发展背景下的科技创新[J].中华神经创伤外科电子杂志,2018,4(4):193-196.
[2]Lefranc M,Capel C,Pruvot AS,et al.The impact of the reference imaging modality,registration method and intraoperative flatpanel computed tomography on the accuracy of the ROSA?Stereotactic robot[J].Stereotact Funct Neurosurg,2014,92(4):242-250.
[3]孙霄,陶英群,许峰,等.ROSA辅助治疗高血压脑出血的优越性及可行性研究[J].中国微侵袭神经外科杂志,2017,22(2):51-53
[4]De Benedictis A,Trezza A,Carai A,et al.Robot-assisted procedures in pediatric neurosurgery[J].Neurosurg Focus,2017,42(5):E7.
[5]孙霄,陶英群,金海,等.ROSA与立体定向框架辅助手术治疗高血压脑出血的对比研究[J].中华神经外科杂志,2018,34(7):674-677.
[6]Vadera S,Chan A,Lo T,et al.Frameless stereotactic robotassisted subthalamic nucleus deep brain stimulation:case report[J].World Neurosurg,2017,97:762.e11-762.e14.
[7]Lefranc M,Capel C,Pruvot-Occean AS,et al.Frameless robotic stereotactic biopsies:a consecutive series of 100 cases[J].JNeurosurg,2015,122(2):342-352.
[8]Brandmeir N,Acharya V,Sather M.Robot assisted stereotactic laser ablation for a radiosurgery resistant hypothalamic hamartoma[J].Cureus,2016,8(4):e581.
[9]Mert A,Kiesel B,W觟hrer A,et al.Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas[J].Neurosurg Focus,2015,38(1):E4
[10]Widmann G,Schullian P,Ortler M,et al.Frameless stereotactic targeting devices:technical features,targeting errors and clinical results[J].Int J Med Robot,2012,8:1-16.
[11]Curry DJ,Gowda A,McNichols RJ,et al.MR-guided stereotactic laser ablation of epileptogenic foci in children[J].Epilepsy Behav,2012,24(4):408-414.
[12]Smith TR,Mithal DS,Stadler JA,et al.Impact of fiducial arrangement and registration sequence on target accuracy using a phantom frameless stereotactic navigation model[J].J Clin Neurosci,2014,21(11):1976-1980.
[13]Kristin J,Mucha D,Schipper J,et al.Registration strategies for the application of the navigation system Fiagon at the lateral scull base[J].Laryngorhinootologie,2012,91(5):306-310.
[14]Zhou C,Anschuetz L,Weder S,et al.Surface matching for highaccuracy registration of the lateral skull base[J].Int J Comput Assist Radiol Surg,2016,11(11):2097-2103.
[15]詹启敏.健康中国发展背景下的科技创新[J].中华神经创伤外科电子杂志,2018,4(4):193-196.