側頭骨領域ナビゲーション手術のための低侵襲リファレンスフレーム

—錐体尖部真珠腫手術での使用経験—

抄録

Navigation system as a supporting tool for surgery exhibits its usefulness particularly in cases where operation is repeated due to a loss in a landmark or where anatomical positions of vein and nerve are complex. Around the temporal bone, there exist many anatomically complex sense organs surrounded by osseous tissues. Operations are aimed at retaining the functions or reconstruction and must avoid inflicting the sense organs, so the navigation system becomes more useful as the operation area spreads deeper such as in cases of petrous apex and inner ear.
On the other hand, the biggest problem relating to navigation technologies for use in otologic and lateral skull base surgery is where to attach the markers that are necessary for spatial measurements on the patient. It is often necessary to move the surgical microscope and to reposit the patient's head in order to adapt to the surgical field, and each time it becomes necessary to measure the intraoperative positional changes of the surgical field. It is necessary to place the markers on the basis of careful anticipation of the movements of the surgical microscope, the position of the surgeon, etc., during the operation. However, unfortunately, the reference flames with the markers attached to the patient in the past was all invasive.
Accordingly, we created a new reference flame less invasive to human body and can be attached to the mouth. The teeth of the upper jaw are the only hard tissue of the human body that is exposed to the outside environment, and the use of the reference frame with markers attached to the mouth makes it possible to carry out highly precise measurements of positional changes of the surgical field.
We can state that this flame is a steady reference flame contributing to further raise the safety of otologic and lateral skull base surgery and at the same time even from the aspect of the spread of navigation surgery in these fields, its contribution can be said to be very high.