背景:放射科提供的计算机断层扫描(CT)图像可能不足以计划用于刚性颅骨连接(CVJ)器械的螺钉。尽管许多人建议使用多平面重建(MPR)与螺钉轨迹一致,这并不总是适用于所有外科医生。本研究旨在为小儿CVJ异常的术前计划提供逐步的工作流程。
方法:在2014年至2019年期间,对25名连续儿童(<12岁)进行了手术治疗。术前CT血管造影图被转移到称为Horos™的开源软件。外科医生在该观察软件中操纵图像以确定螺钉的理想化路径。生成病理解剖学的三维体绘制,并注意到异常情况。外科医生将使用Horos™获得的解剖数据与从原始成像平台获得的解剖数据进行比较,并将其分级为A级(大量新信息),B级(验证性,提高可视化和理解),C级(无补充信息)。然后,外科医生执行使用Horos™确定的手术计划。
结果:进行的手术是枕颈(n=18,72%)和寰枢椎固定术(n=7,28%),平均年龄为7.2岁,72%的病因是先天性或发育不良。在18名(72%)患者中,与原始成像平台相比,外科医生注意到Horos™上有关CVJ异常的大量新信息(A级).关于固定锚的规划,外科医生对所有患者进行A级(100%)。在4名(16%)患者中,手术无法按计划进行。有三种(12%)并发症;VA损伤(n=1),神经系统恶化(n=1),和固定丧失(n=1)。
结论:根据我们的经验,与研究原始成像平面相比,外科医生指导的成像操作提供了更多的解剖学信息,应纳入外科医生的术前检查。当图像重新格式化选项受限时,像Horos™这样的开源软件可能会提供优势。
BACKGROUND: Computed tomography (CT) images provided by the radiology department may be inadequate for planning screws for rigid
craniovertebral junction (CVJ) instrumentation. Although many recommend using multiplanar reconstruction (MPR) in line with screw trajectories, this is not always available to all surgeons. The current study aims to present a step-by-step workflow for preoperative planning for pediatric CVJ anomalies.
METHODS: Twenty-five consecutive children (<12 years) were operated for atlantoaxial instability between 2014 and 2019. Preoperative CT angiograms were transferred to an open-source software called Horos™. The surgeon manipulated images in this viewing software to determine an idealized path of screws. Three-dimensional volume rendering of the pathoanatomy was generated, and anomalies were noted. The surgeon compared the anatomical data obtained using Horos™ with that from the original imaging platform and graded it as; Grade A (substantial new information), Grade B (confirmatory with improved visualization and understanding), Grade C (no added information). The surgeon then executed the surgical plan determined using Horos™.
RESULTS: Surgeries performed were occipitocervical (n = 18, 72%) and atlantoaxial fixation (n = 7, 28%) at a mean age of 7.2 years, with 72% of etiologies being congenital or dysplasias. In 18 (72%) patients, the surgeon noted substantial new information (Grade A) about CVJ anomalies on Horos™ compared to original imaging platform. Concerning planning for fixation anchors, the surgeon graded A in all patients (100%). In 4 (16%) patients, the surgery could not be executed precisely as planned. There were three (12%) complications; VA injury (n = 1), neurological worsening (n = 1), and loss of fixation (n = 1).
CONCLUSIONS: In our experience, surgeon-directed imaging manipulation gives more anatomical information compared to studying original imaging planes and should be incorporated in the surgeon\'s preoperative workup. When image reformatting options are limited, open-source software like Horos™ may offer advantages.