'표식자'를 이용한 정위적 뇌종양 제거술 - 수술기법 -
Stereotactic Resection of the Brain Tumor Using 'Tailed Bullets' - Technical Note -
조경기, 안영환,
소속 상세정보
조경기 ( )
아주대학교 화학생물공학부 생명공학전공
안영환 ( )
아주대학교 의과대학 신경외과학교실
KMID : 0359819980270050009
Abstract
서론
중뇌를 비롯하여 시상, 시상하부와 뇌기저핵, 등의 중요한 구조물들 주변에 발생한 천막상
뇌종양은 수술적 제거가 어렵다. 특히 신경교종은 침습적으로 자라고, 수술 시야에서도 정상
조직과의 경계가 불분명해서 완전 제거뿐만 아니라 수술자가 계획한 만큼의 제거가 어렵다.
최근에는 영상 진단 및 뇌정위 장비와 컴퓨터를 이용하여 종양을 제거할 수 있는 다양한
수술 방법이 시행되고 있고 최근 Neuronavigation system의 도입으로 종양의 수술적 제거
가 더욱 용이해졌다. 그러나 Neuronavigation system은 아직 해결되어야 할 2가지 문제점들
을 가지고 있다. 첫 번째 문제점은 수술중 종양 제거에 따른 '뇌전위(brain shifting)'이며,
두 번째는 장비들이 고가인데 반한 그 효용성의 제한이다
The interactive image-guided stereotactic system can provide a real-time surgical
localization and guidance for complete removal ol the tumor. However, this system has
limitation with respect to the resection of deep-seated tumors because once the tumor is
removed. the brain and the margin of tumors shift toward the area previously occupied
by the tumor. We present a new operative technique for determining the resection
margin of deep-seated tumors using a visual marker called a 'tailed bullet' to overcome
the problem mentioned above.
Preoperative enhanced computed tomograms or magnetic resonance imagings were
performed with the aid of the along with the aid of the Leksell frame. The enhancing
margin of the tumor was defined as a resection margin. Several points(10-15) of the
tumor margin on the enhanced imaging were chosen and localized After usual
craniotomy. multiple tailed bullets were inserted into the target point just before the
opening of the dura. As the tumor was removed. the brain began to move along with
the tailed bullets. thus enable us to continue tracking the tumor margin by following the
bullet's location.
There are substantial benefits of this surgical technique. it can be easily applied to
any kind stereotactic frame without incurring other expenses it is more cost-efficient
than the neuronavigation system. This surgical procedure is also safe and simple to use
for overcoming the limitation of neuronavigation system. since the movement of the
bullets with the brain can be easily traced thus lowering the mortablity and morbidity
of brain tumor resection. This surgical technique is especially useful in glioma surgery.
Brain tumor; Stereotactic determination; Tailed bulit, Image guided stereotaxis; Computed tomography; Magnetic resonance image.;
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