C Dureza | PubMed Health

PubMed2000

Minimally invasive surgical exposure of the extreme high cervical internal carotid artery: anatomical study.

The purpose of this study is to investigate a minimally invasive access to a high cervical lesion involving the internal carotid artery. Using 13 fixed cadaveric preparations, we sought to design a surgical approach that would cause minimal involvement of the surrounding structures and maximal exposure to the extreme high cervical area. This technique preserves the function and integrity of the mandible, sternocleidomastoid, posterior belly of digastric and styloid process muscles. The method uses retraction and mobilisation of those muscles, as well as decompression of the facial from the stylomastoid foramen. The internal carotid artery is exposed up to the entry point into the carotid canal. The cranial nerves IX, X, XI and XII are kept in sight up to the jugular foramen. This approach creates a wide corridor into the deep high cervical and inferior cranial base area and can be utilised for high cervical carotid lesions and tumours related to the artery.

Aged↗

PubMed1997

Computer navigational microscope for minimally invasive neurosurgery.

Frameless navigational devices have recently undergone an evoluation to the point where they are being used more efficiently in the clinical setting. Most of the present-day systems utilize some form of mechanical arm to correlate registered points in space to the computer terminal. However, the articulated arm can be cumbersome and is an additional obstacle in the surgical field. To avoid this problem some groups have elected to transmit registered points and probe position using ultrasound or electromagnetic fields. However, in using magnetic fields, ferromagnetic metals can interfere with accuracy. On the other hand with ultrasonic digitizers accuracy is dependent on variable factors such as humidity, local temperature, and positioning of the emitters. In response to some of these difficulties inherent with frameless stereotaxy, the MKM system was developed. Essentially it is an optically based system in which the CT and/or MRI data are superimposed three-dimensionally onto the surgical field as seen through the microscope using head-up display technology. It requires no opto-kinetic link such as a headframe, mechanical arm, ultrasonic, and magnetic field. We have used the MKM microscope system to guide 18 neurosurgical procedures. This report illustrates the advantages of this system when combined with keyhole surgery to provide accurate excision of brain lesions while preserving normal tissue.

Adolescent↗