机器人立体定向辅助系统手术在儿童癫痫和肌张力障碍中的应用

摘要

目的 探讨机器人立体定向辅助系统在儿童患者中应用的安全性和有效性.方法 自2016年10月至2017年1月对24名需要立体定向手术的儿童患者,采用机器人立体定向辅助系统(ROSA).术前使用ROSA设定电极入点和靶点,术中应用ROSA确定入点、方向和深度,术后评估安全性和疗效.结果 24例儿童患者平均年龄7.5岁(3～16岁),平均病史4年(1～9年).共植入210根深部电极,13例进行单侧植入,11例进行双侧植入.其中包括额叶90根,颞叶68根,枕叶10根,顶叶26根,岛叶12根,苍白球4根.平均每根电极植入时间小于10 min.术后复查CT,与术前MRI相融合之后分析,可见各电极末端位置与植入术前计划靶点位置基本一致,平均位置误差2.6 mm(0.3 ～5.9 mm).1例患者在颞骨入颅点周围有蛛网膜下腔出血,无不适表现.本组患者无颅内血肿、电极脱出等并发症.结论 ROSA引导立体定向植入儿童颅内深部电极,克服了传统框架式立体定向仪在儿童的应用局限,且更加安全、精准、便捷.%Objective The safety and efficacy of robotized stereotactic assistant system in pediatric patients were discussed.Methods From October 2016 to January 2017,24 pediatric patients required stereotactic surgery were treated with a robotic stereotactic assist system (ROSA).Pre-operative ROSA was used to set the electrode insertion point and target point.Intra-operative ROSA was used to determine the insertion point,direction and depth.After operation the safety and efficacy were evaluated.Results The average age of 24 children was 7.5 years (3 years ～16 years).The average medical history was 4 years (1 year ～9 years).A total of 210 deep electrodes were implanted including 13 cases undergoing unilateral implantation and 11 cases undergoing bilateral implantation,including 90 frontal lobes,68 temporal lobes,10 occipital lobes,26 parietal lobes,12 insular lobes,and 4 globus pallidus.The average implantation time of each electrode was less than 10 min.After the follow-up of CT and the pre-operative MRI fusion,it was found that the end of each electrode was basically consistent with the target location before implantation,and the average position error was 2.6 mm (0.3 ～ 5.9 mm).One patient had subarachnoid hemorrhage around the cranial bone at the site of the cranial bone and showed no signs of discomfort.There was no complication such as intracranial hematoma and electrode prolapse.Conclusion ROSA guided stereotactic implantation of deep intracranial electrodes in children can overcome the limitations of traditional frame stereotactic instrument in children,and it is safer,more accurate and convenient.