摘要
目的探讨多模态影像三维重建联合神经导航在功能区胶质瘤手术中的作用。方法回顾性分析2018年4月至2021年3月于北京大学第三医院神经外科行手术治疗的30例累及功能区胶质瘤患者的临床资料。术前将患者的头颅增强MRI、弥散张量成像CT血管成像(或磁共振血管成像)等数据进行影像融合以重建神经纤维束、肿瘤、血管、颅骨等结构,从而设计最佳手术路径,并应用于神经导航指导肿瘤的切除。术后72h复查头颅MRI以判断肿瘤切除程度。术后1周、1个月及3个月分别采用波土顿诊断性失语症检查量表评估语言功能,采用简化Fugl-Meyer运动功能量表评估运动功能。结果通过三维影像重建结果,所有患者均可清晰显示肿瘤与周围的重要神经纤维束、动脉、静脉等的解剖关系,明确神经纤维束的位移和破坏、供血动脉及引流静脉情况。30例患者中,肿瘤累及运动区21例,累及语言区25例。肿瘤全切除28例(93.3%),次全切除2例(6.7%)。21例术前存在神经功能缺损症状的患者中,末次随访时,20例术后神经功能改善,1例神经功能同术前;9例术前无神经功能缺损症状的患者术后出现一过性神经功能缺失相关症状,1周后症状消失。结论应用多模态影像三维重建肿瘤及周围神经纤维束、血管等重要结构,从而设计手术入路并应用于术中导航以指导手术,有助于对脑功能区的保护并提高手术疗效。
Objective To investigate the role of three-dimensional reconstruction of multi-modal images combined with neuronavigation in the operation of gliomas in eloquent regions.Methods A retrospective analysis was conducted on the clinical data of 30 patients with gliomas in eloquent regions who underwent surgical treatment at the Department of Neurosurgery of Peking University Third Hospital from April 2018 to March 2021.Before surgery,the patient’s skull MRI with enhancement,diffusion tensor imaging(DTI),and CT angiography(or magnetic resonance angiography)data were fused to reconstruct nerve tracts,tumors,blood vessels,skulls and other structures,so as to design the optimal surgical path,and used in neuronavigation to guide tumor resection.Degree of tumor resection was evaluated by using MRI results 72 hour post operation.One week,one month,and three months after surgery,the Boston Diagnostic Aphasia Examination(BDAE)was used to assess language function,and the simplified Fugl-Meyer Assessment(FMS)was used to assess motor function.Results Through the three-dimensional image reconstruction,the anatomical relationship in all patients between the tumor and surrounding important structures such as nerve tracts,arteries and veins were clearly shown,the displacement and destruction of the nerve tracts were clarified,and the blood supply arteries and drainage veins were shown.Among the 30 patients,the tumor involved the motor area in 21 cases and language area in 25 cases.Totally resection was achieved in 28 cases(93.3%)and subtotal resection in 2 cases(6.7%).Among the 21 patients with preoperative neurological deficits,at the last follow-up,20 patients had improved neurological function after surgery,and 1 patient had unchanged neurological function compared with presurgical conditions.Nine patients who had no neurological deficits before surgery developed transient symptoms related to neurological deficits after surgery,which resolved after 1 week.Conclusion The use of multimodal images to three-dimensionally reconstruc
作者
陈素华
杨军
陈新
孙建军
马长城
林国中
韩芸峰
司雨
吴超
杨辰龙
Chen Suhua;Yang Jun;Chen Xin;Sun Jianjun;Ma Changcheng;Lin Guozhong;Han Yunfeng;Si Yu;Wu Chao;Yang Chenlong(Department of Neurosurgery,Peking University Third Hospital,Center for Precision Neurosurgery and Oncology of Peking University Health Science Center,Beijing 100191,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第9期874-879,共6页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(82072774,81872051)
北京大学临床科学家计划(BMU2019-LCKXJ007)
北京大学第三医院临床重点项目(BYSY2018060)。
关键词
神经胶质瘤
神经外科手术
多模态影像
三维重建
脑功能区
Gliomas
Neurosurgical procedures
Multimodal images
Three-dimensional reconstruction
Eloquent regions