Stereotaxic Techniques

立体定位技术
  • 文章类型: Journal Article
    背景:今天,肺结节的检出率越来越高。这些结节中的一些可能变成恶性。因此,及时切除潜在的恶性结节至关重要.然而,在手术期间识别非表面或软纹理结节的位置是具有挑战性的。已经开发了各种定位技术来准确地识别肺结节。常见的方法包括术前CT引导经皮放置钩丝和微线圈。尽管如此,这些手术可能会引起气胸和血胸等并发症。关于肺结节的定位的其他方法具有其自身的缺点。我们进行了一项临床研究,该研究是回顾性的,确定肺结节定位的准确和合适的方法。探讨CT辅助体表定位联合术中立体定向解剖定位在胸腔镜肺结节切除术中的临床应用价值。
    方法:我们回顾性收集了在胸外科接受肺结节定位切除手术的120例患者的临床资料,蚌埠医学院第一附属医院,从2020年1月到2022年1月。其中,30例患者行CT辅助体表定位联合术中立体定向解剖定位,30例患者仅接受CT辅助体表定位,30例患者仅接受术中立体定向解剖定位,30例患者接受了CT引导下经皮微线圈定位。成功率,并发症发生率,并对四种肺结节定位方法的定位次数进行统计分析。
    结果:CT辅助体表定位联合术中立体定向解剖定位和CT引导下经皮微弹簧圈定位的成功率均为96.7%,CT辅助体表定位组成功率70.0%,差异有统计学意义(P<0.05)。联合组并发症发生率为0%,显著低于微线圈定位组的60%(P<0.05)。联合组的定位时间为17.73±2.52min,显着小于微线圈定位组的(27.27±7.61min)(P<0.05)。
    结论:CT辅助体表定位结合术中立体定向解剖定位是一种安全的,无痛,准确,肺结节定位的可靠方法。
    BACKGROUND: Today, the detection rate of lung nodules is increasing. Some of these nodules may become malignant. Thus, timely resection of potentially malignant nodules is essential. However, Identifying the location of nonsurface or soft-textured nodules during surgery is challenging. Various localization techniques have been developed to accurately identify lung nodules. Common methods include preoperative CT-guided percutaneous placement of hook wires and microcoils. Nonetheless, these procedures may cause complications such as pneumothorax and haemothorax. Other methods regarding localization of pulmonary nodules have their own drawbacks. We conducted a clinical study which was retrospective to identify a safe, accurate and suitable method for determining lung nodule localization. To evaluate the clinical value of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection.
    METHODS: We retrospectively collected the clinical data of 120 patients who underwent lung nodule localization and resection surgery at the Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, from January 2020 to January 2022. Among them, 30 patients underwent CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization, 30 patients underwent only CT-assisted body surface localization, 30 patients underwent only intraoperative stereotactic anatomical localization, and 30 patients underwent CT-guided percutaneous microcoil localization. The success rates, complication rates, and localization times of the four lung nodule localization methods were statistically analysed.
    RESULTS: The success rates of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization and CT-guided percutaneous microcoil localization were both 96.7%, which were significantly higher than the 70.0% success rate in the CT-assisted body surface localization group (P < 0.05). The complication rate in the combined group was 0%, which was significantly lower than the 60% in the microcoil localization group (P < 0.05). The localization time for the combined group was 17.73 ± 2.52 min, which was significantly less than that (27.27 ± 7.61 min) for the microcoil localization group (P < 0.05).
    CONCLUSIONS: CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization is a safe, painless, accurate, and reliable method for lung nodule localization.
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  • 文章类型: Journal Article
    背景和目的:由于脑部病变存在复杂的诊断挑战,通过活检进行准确的组织采样对于有效的治疗计划至关重要。传统的基于框架的立体定向活检已得到导航活检技术的补充。利用成像和导航技术的进步。本研究旨在在临床环境中比较导航和基于框架的立体定向活检方法,评估它们的功效,安全,和诊断结果,以确定精确的脑部病变靶向的最佳方法。材料和方法:回顾性分析2017年1月至2023年8月在学术医学中心接受脑活检的患者。患者人口统计数据,临床特征,活检技术(导航与基于框架),结果包括准确性,并发症,并对住院时间进行分析。结果:该队列包括112例患者,组间年龄或性别差异无统计学意义。导致活检的症状主要是肌肉力量减弱(42.0%),认知问题(28.6%),失语症(24.1%)。肿瘤最常见于深半球(24.1%)。中位住院时间为5天,再住院率为27.7%。4.47%的患者出现并发症,活检方法之间没有显着差异。然而,导航活检导致样本较少(p<0.001),但与基于帧的活检具有相当的诊断准确性.结论:导航和基于框架的立体定向活检既有效又安全,具有可比的准确性和并发症发生率。技术的选择应考虑病变的具体情况,外科医生偏好,和技术可用性。研究结果强调了先进的神经外科技术在增强患者护理和预后方面的重要性。
    Background and Objectives: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based stereotactic biopsy has been complemented by navigated biopsy techniques, leveraging advancements in imaging and navigation technology. This study aims to compare the navigated and frame-based stereotactic biopsy methods in a clinical setting, evaluating their efficacy, safety, and diagnostic outcomes to determine the optimal approach for precise brain lesion targeting. Materials and Methods: retrospective analysis was conducted on patients who underwent brain biopsies between January 2017 and August 2023 at an academic medical center. Data on patient demographics, clinical characteristics, biopsy technique (navigated vs. frame-based), and outcomes including accuracy, complications, and hospital stay duration were analyzed. Results: The cohort comprised 112 patients, with no significant age or gender differences between groups. Symptoms leading to biopsy were predominantly diminished muscle strength (42.0%), cognitive issues (28.6%), and aphasia (24.1%). Tumors were most common in the deep hemisphere (24.1%). The median hospital stay was 5 days, with a rehospitalization rate of 27.7%. Complications occurred in 4.47% of patients, showing no significant difference between biopsy methods. However, navigated biopsies resulted in fewer samples (p < 0.001) but with comparable diagnostic accuracy as frame-based biopsies. Conclusions: Navigated and frame-based stereotactic biopsies are both effective and safe, with comparable accuracy and complication rates. The choice of technique should consider lesion specifics, surgeon preference, and technological availability. The findings highlight the importance of advanced neurosurgical techniques in enhancing patient care and outcomes.
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  • 文章类型: Journal Article
    目的:原发性中枢神经系统淋巴瘤(PCNSL)诊断的金标准是立体定向活检后的组织病理学诊断。然而,PCNSL有多学科诊断工作,这与诊断延迟有关,并可能导致治疗延迟。本文为参与PCNSL患者(新型)诊断和护理的临床决策的神经外科医生提供建议,旨在提高PCNSL患者诊断过程的统一性和及时性。
    方法:我们提出了一个小型综述,以讨论立体定向活检在PCNSL诊断新发展的背景下的作用。以及细胞减灭术的作用。
    结果:基于脑脊液的诊断是辅助诊断,不能取代基于立体定向活检的诊断。
    结论:脑立体定向活检后的组织病理学诊断仍然是诊断的金标准。额外的诊断不应是诊断延迟的原因。目前没有足够的证据支持PCNSL的细胞减灭术,最近的研究显示矛盾的数据和次优的研究设计。
    OBJECTIVE: The gold standard for diagnostics in primary central nervous system lymphoma (PCNSL) is histopathological diagnosis after stereotactic biopsy. Yet, PCNSL has a multidisciplinary diagnostic work up, which associated with diagnostic delay and could result in treatment delay. This article offers recommendations to neurosurgeons involved in clinical decision-making regarding (novel) diagnostics and care for patients with PCNSL with the aim to improve uniformity and timeliness of the diagnostic process for patients with PCNSL.
    METHODS: We present a mini review to discuss the role of stereotactic biopsy in the context of novel developments in diagnostics for PCNSL, as well as the role for cytoreductive surgery.
    RESULTS: Cerebrospinal fluid-based diagnostics are supplementary and cannot replace stereotactic biopsy-based diagnostics.
    CONCLUSIONS: Histopathological diagnosis after stereotactic biopsy of the brain remains the gold standard for diagnosis. Additional diagnostics should not be a cause of diagnostic delay. There is currently no sufficient evidence supporting cytoreductive surgery in PCNSL, with recent studies showing contradictive data and suboptimal study designs.
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  • 文章类型: Journal Article
    行为动物的细胞外记录可用于建立神经元活动和行为之间的关联。这里,我们描述了如何记录参与行为任务的猴子的外部苍白球(GPe)。我们详细介绍了腔室和头部支架植入的立体定位手术,术后MRI扫描以确定GPe坐标并验证腔室的位置,和数据收集。该协议使得可以检查行为猴子中GPe神经元的电生理特征。有关此协议的使用和执行的完整详细信息,PleaserefertoKatabietal.1.
    Extracellular recordings in behaving animals are useful for establishing associations between neuronal activity and behavior. Here, we describe how to record in the external globus pallidus (GPe) of monkeys engaged in a behavioral task. We detail the stereotaxic surgery for chamber and head-holder implantation, the post-operative MRI scan to ascertain the GPe coordinates and validate the position of the chamber, and the data collection. This protocol makes it possible to examine the electrophysiological features of GPe neurons in behaving monkeys. For complete details on the use and execution of this protocol, please refer to Katabi et al.1.
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  • 文章类型: Journal Article
    背景:非人类灵长类动物(NHP)的高精度神经外科靶向通常需要使用非侵入性神经成像技术(MRI,CT,PET),允许将单个解剖坐标平移到外科立体定向装置。鉴于这些成像技术产生的各种组织对比,基于成像的坐标与外科器械的精确对准可能是麻烦的。与MRI兼容的立体定位与不透射线的基准标记提供了一个直接和可靠的解决方案,但现有的商业选项不适合共形头部线圈,最大限度地提高成像质量。
    方法:我们开发了一种适用于多种NHP物种(猕猴,猕猴,和Cebusapella),允许通过技术特定的基准标记进行多模态对齐。
    方法:出于与临床可用MRI兼容的明确目的,CT,和PET系统,框架不大于人类的头部,同时允许在仰卧位对NHPs进行成像。这种设计不需要植入标记物,特殊软件,或除普通大型动物立体定向操作外的其他知识。
    结果:我们证明了这种3D打印设备在需要术前计划的各种实验中的适用性:1)我们通过MRI套管内插入和皮质下注射证明了基准系统的准确性病毒载体。2)我们还证明了多模态(MRI和CT)对准和坐标传递的准确性,以指导用于深脑电生理的手术机器人电极植入。
    结论:计算机辅助设计文件和工程图是公开的,与模块化设计允许低成本和可管理的制造。
    BACKGROUND: High-precision neurosurgical targeting in nonhuman primates (NHPs) often requires presurgical anatomical mapping with noninvasive neuroimaging techniques (MRI, CT, PET), allowing for translation of individual anatomical coordinates to surgical stereotaxic apparatus. Given the varied tissue contrasts that these imaging techniques produce, precise alignment of imaging-based coordinates to surgical apparatus can be cumbersome. MRI-compatible stereotaxis with radiopaque fiducial markers offer a straight-forward and reliable solution, but existing commercial options do not fit in conformal head coils that maximize imaging quality.
    METHODS: We developed a compact MRI-compatible stereotaxis suitable for a variety of NHP species (Macaca mulatta, Macaca fascicularis, and Cebus apella) that allows multimodal alignment through technique-specific fiducial markers.
    METHODS: With the express purpose of compatibility with clinically available MRI, CT, and PET systems, the frame is no larger than a human head, while allowing for imaging NHPs in the supinated position. This design requires no marker implantation, special software, or additional knowledge other than the operation of a common large animal stereotaxis.
    RESULTS: We demonstrated the applicability of this 3D-printable apparatus across a diverse set of experiments requiring presurgical planning: 1) We demonstrate the accuracy of the fiducial system through a within-MRI cannula insertion and subcortical injection of a viral vector. 2) We also demonstrated accuracy of multimodal (MRI and CT) alignment and coordinate transfer to guide a surgical robot electrode implantation for deep-brain electrophysiology.
    CONCLUSIONS: The computer-aided design files and engineering drawings are publicly available, with the modular design allowing for low cost and manageable manufacturing.
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  • 文章类型: Journal Article
    神经元振荡通常用功率谱方法分析,量化信号幅度,但不是节律性或“振荡性”本身。这里我们介绍一种新方法,相位自相关函数(pACF),用于直接量化节律性。我们将pACF应用于人类脑内立体脑电图(SEEG)和脑磁图(MEG)数据,并在单频和多频神经元振荡的节律中发现了频谱和解剖学上细粒度的皮层结构。证明了节律性的功能意义,我们发现它是静息状态网络中远程同步的先决条件,并且在与事件相关的处理过程中进行动态调制。我们还扩展了pACF方法来测量振荡过程的“突发性”,并表征了具有稳定和突发性振荡的区域。这些发现表明,节律性与振幅是双重分离的,并且构成了神经元振荡的功能相关和动态特征。
    Neuronal oscillations are commonly analyzed with power spectral methods that quantify signal amplitude, but not rhythmicity or \'oscillatoriness\' per se. Here we introduce a new approach, the phase-autocorrelation function (pACF), for the direct quantification of rhythmicity. We applied pACF to human intracerebral stereoelectroencephalography (SEEG) and magnetoencephalography (MEG) data and uncovered a spectrally and anatomically fine-grained cortical architecture in the rhythmicity of single- and multi-frequency neuronal oscillations. Evidencing the functional significance of rhythmicity, we found it to be a prerequisite for long-range synchronization in resting-state networks and to be dynamically modulated during event-related processing. We also extended the pACF approach to measure \'burstiness\' of oscillatory processes and characterized regions with stable and bursty oscillations. These findings show that rhythmicity is double-dissociable from amplitude and constitutes a functionally relevant and dynamic characteristic of neuronal oscillations.
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  • 文章类型: Journal Article
    目的:后颅窝(脑干和小脑)的病变在诊断和治疗中具有挑战性,因为它们通常位于雄辩位置,并且很少可能完全切除。因此,基于框架的立体定向活检通常用于对组织进行神经病理学诊断和进一步治疗确定。我们研究的目的是评估通过枕下-经小脑入路对后颅窝病变进行基于框架的立体定向活检的安全性和诊断成功率。
    方法:自2007年以来,我们对我们机构的所有基于框架的立体定向活检病例进行了回顾性数据库分析。目的是通过枕下经小脑入路确定所有手术病例进行幕下病变活检。我们收集了关于结果的临床数据,并发症,诊断成功,放射学外观,和立体定位轨迹。
    结果:确定了n=79例采用Zamorano-Duchovny立体定向系统通过枕下-经小脑入路(41名女性和38名男性)进行后颅窝病变的立体定向活检。手术时的平均年龄为42.5岁(±23.3;范围,1-87岁)。所有患者均进行术中立体定向成像(n=62MRI,n=17CT)。绝对诊断成功率为87.3%。最常见的诊断是神经胶质瘤,淋巴瘤和炎症性疾病。总并发症发生率为8.7%(7例)。所有有并发症的患者都表现出新的神经功能缺损;其中,三是永久性的。在有并发症的病例中发现了出血。30天死亡率为7.6%,1年生存率为70%。
    结论:我们的数据表明,采用Zamorano-Duchovny立体定向系统通过枕下-小脑入路进行的基于框架的立体定向活检对于具有高诊断率和可接受的并发症率的幕下病变是安全可靠的。进一步的研究应集中在安全轨迹的计划和仔细的病例选择上,以最大程度地减少并发症和最大程度地提高诊断成功率。
    OBJECTIVE: Lesions of the posterior fossa (brainstem and cerebellum) are challenging in diagnosis and treatment due to the fact that they are often located eloquently and total resection is rarely possible. Therefore, frame-based stereotactic biopsies are commonly used to asservate tissue for neuropathological diagnosis and further treatment determination. The aim of our study was to assess the safety and diagnostic success rate of frame-based stereotactic biopsies for lesions in the posterior fossa via the suboccipital-transcerebellar approach.
    METHODS: We performed a retrospective database analysis of all frame-based stereotactic biopsy cases at our institution since 2007. The aim was to identify all surgical cases for infratentorial lesion biopsies via the suboccipital-transcerebellar approach. We collected clinical data regarding outcomes, complications, diagnostic success, radiological appearances, and stereotactic trajectories.
    RESULTS: A total of n = 79 cases of stereotactic biopsies for posterior fossa lesions via the suboccipital-transcerebellar approach (41 female and 38 male) utilizing the Zamorano-Duchovny stereotactic system were identified. The mean age at the time of surgery was 42.5 years (± 23.3; range, 1-87 years). All patients were operated with intraoperative stereotactic imaging (n = 62 MRI, n = 17 CT). The absolute diagnostic success rate was 87.3%. The most common diagnoses were glioma, lymphoma, and inflammatory disease. The overall complication rate was 8.7% (seven cases). All patients with complications showed new neurological deficits; of those, three were permanent. Hemorrhage was detected in five of the cases having complications. The 30-day mortality rate was 7.6%, and 1-year survival rate was 70%.
    CONCLUSIONS: Our data suggests that frame-based stereotactic biopsies with the Zamorano-Duchovny stereotactic system via the suboccipital-transcerebellar approach are safe and reliable for infratentorial lesions bearing a high diagnostic yield and an acceptable complication rate. Further research should focus on the planning of safe trajectories and a careful case selection with the goal of minimizing complications and maximizing diagnostic success.
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  • 文章类型: Journal Article
    立体脑电图是一种强大的脑内脑电图记录方法,用于术前评估癫痫。它包括在患者的大脑中植入深度电极,以记录电活动并绘制癫痫区,应该切除以使患者无癫痫发作。立体脑电图具有很高的空间精度和信噪比,但在探索的大脑区域的覆盖范围仍然有限。因此,植入可能提供癫痫发生区域的次优采样。我们研究了通过对立体脑电图信号进行源定位来改善次优立体脑电图记录的潜力。我们建议结合独立成分分析,连通性措施,以识别感兴趣的组件,和分布式源建模。这种方法在两名患者身上进行了测试,第一个未能表征癫痫发生区,第二个未能给出更好的诊断。我们证明了对第一次立体脑电图记录进行的发作和发作间源定位与第二次立体脑电图探索的发现相匹配。我们的发现表明,独立成分分析,然后在感兴趣的地形图上进行源定位是在植入次优情况下检索癫痫发生区的有希望的方法。
    Stereoelectroencephalography is a powerful intracerebral EEG recording method for the presurgical evaluation of epilepsy. It consists in implanting depth electrodes in the patient\'s brain to record electrical activity and map the epileptogenic zone, which should be resected to render the patient seizure-free. Stereoelectroencephalography has high spatial accuracy and signal-to-noise ratio but remains limited in the coverage of the explored brain regions. Thus, the implantation might provide a suboptimal sampling of epileptogenic regions. We investigate the potential of improving a suboptimal stereoelectroencephalography recording by performing source localization on stereoelectroencephalography signals. We propose combining independent component analysis, connectivity measures to identify components of interest, and distributed source modelling. This approach was tested on two patients with two implantations each, the first failing to characterize the epileptogenic zone and the second giving a better diagnosis. We demonstrate that ictal and interictal source localization performed on the first stereoelectroencephalography recordings matches the findings of the second stereo-EEG exploration. Our findings suggest that independent component analysis followed by source localization on the topographies of interest is a promising method for retrieving the epileptogenic zone in case of suboptimal implantation.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    体内细胞外场电位记录是现代神经科学研究中常用的技术。长期电生理记录的成功通常取决于植入手术的质量。然而,视觉引导的立体定位神经外科和eLab/ePulse电生理系统在啮齿动物模型中的应用有限。本研究提供了使用eLab/ePulse电生理系统在啮齿动物模型中进行手术电极植入的实用和功能手册指南,用于记录和刺激目的,以评估神经元功能和突触可塑性。评估参数包括输入/输出函数(IO),配对脉搏促进或抑郁(PPF/PPD),长期增强(LTP),和长期抑郁症(LTD)。•为进行体内立体定向神经外科提供详细的图片引导程序。•具体包括海马电极的插入和诱发的细胞外场电位的记录。
    In vivo extracellular field potential recording is a commonly used technique in modern neuroscience research. The success of long-term electrophysiological recordings often depends on the quality of the implantation surgery. However, there is limited use of visually guided stereotaxic neurosurgery and the application of the eLab/ePulse electrophysiology system in rodent models. This study presents a practical and functional manual guide for surgical electrode implantation in rodent models using the eLab/ePulse electrophysiology system for recording and stimulation purposes to assess neuronal functionality and synaptic plasticity. The evaluation parameters included the input/output function (IO), paired-pulse facilitation or depression (PPF/PPD), long-term potentiation (LTP), and long-term depression (LTD).•Provides a detailed picture-guided procedure for conducting in vivo stereotaxic neurosurgery.•Specifically covers the insertion of hippocampal electrodes and the recording of evoked extracellular field potentials.
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