功能性计算机导航在肿瘤性骨软化症手术中的应用实践OA

Objective To summarize the surgical workflow,technical feasibility and preliminary clinical value of functional computer navigation that integrates somatostatin receptor positron emission tomography/computed tomography(SSTR-PET/CT)into an intraoperative computer navigation system for surgery in patients with tumor-in-duced osteomalacia(TIO).Methods Five patients with TIO who underwent functional computer navigation assisted resection of the causative lesion were retrospectively included.All patients underwent preoperative clinical,biochemical and imaging evaluations.Functional high-uptake information identified on SSTR-PET/CT was fused with CT anatomical images and imported into the intraoperative navigation platform.Baseline characteristics,image fusion and navigation procedures,surgical methods,pathological findings,postoperative serum phosphate recovery,symptom improvement and complications were analyzed descriptively.Results Among the five patients,three were female and two were male,with a median age of 39 years and a median disease duration of 3 years.Preoperative serum phosphate levels ranged from 0.37 to 0.50 mmol/L.All patients underwent preoperative tumor localization using Al 18 F-NOTA-LM3-PET/CT or 68 Ga-DOTATATE-PET/CT combined with anatomical imaging.Image fusion,navigation data import,intra-operative registration and navigated lesion localization were successfully completed in all five cases.Surgical procedures included curettage of bone lesions or excision of soft-tissue lesions.Pathology confirmed phosphaturic mesenchymal tumor in all cases.Four patients achieved normalization of serum phosphate levels accompanied by symptomatic improve-ment after surgery,corresponding to a biochemical remission rate of 80.0%(4/5).In the remaining patient with mul-tifocal disease,hypophosphatemia persisted postoperatively,given the presence of multiple lesions and pulmonary mi-cronodules,residual causative lesions were suspected.No surgery-related complications occurred in any patient.Conclusion Functional computer navigation can translate metabolic activity information from SSTR-PET/CT into an in-traoperative localization reference,demonstrating good feasibility and safety in this series of patients with TIO.This technique may be particularly useful for cases involving occult lesions,complex anatomical locations or altered anatomy due to previous surgery.However,its impact on biochemical remission and recurrence risk requires validation in larger prospective studies.