多影像融合技术在神经导航手术的临床应用  

Application of multi-image-merged techniques in neuronavigation surgery

作　　者：吴劲松[1] 周良辅[1] 高歌军[2] 洪汛宁[2] 毛颖[1] 杜固宏[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]复旦大学附属华山医院放射科,上海200040

出　　处：《中华神经外科杂志》2005年第4期227-231,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨多影像融合技术在神经导航手术的临床应用价值。方法2001年10月至2002年8月,48例神经导航手术采用了多影像融合技术,病灶涉及部位包括:大脑半球功能区32例,颅底12例,其他4例。其中,CT+MRI-T1W影像融合9例;MRI-T1W+FLAIR影像融合5例;MRI-T1W+fMRI-BOLD影像融合14例;MRI-T1W+DTI影像融合13例;MRI-T1W+fMRI-BOLD+DTI影像融合5例;MRI-T1W+FLAIR+fMRI-BOLD+DTI融合2例。结果病灶全切38例(79.2%),次全切除5例(10.4%),大部或部分切除2例,活检1例。术后1个月随访优良率(Karnofsky预后评分,KPS=90～100)72.9%,死亡1例(2.1%),2例(4.2%)发生严重手术致残(KPS=40)。结论多影像融合技术应用于神经导航可以提供更多的影像信息,实现个体化、最优化的术前计划和术中应变。在精确定位肿瘤的同时,还可以界定其与不同性质的解剖、功能结构间毗邻关系,符合最小创伤功能神经外科的发展趋势。Objective To evaluate the usefulness of multi-image-merged techniques in neuronavigation surgery of brain tumors.Methods Multi-image-merged neuronavigation surgery was undertaken in 48 patients, among whom eloquent areas were involved in 32 cases,skull base in 12 cases,and others in 4cases. There were 9 cases of CT+MRI-T 1W fusion, 5 cases of MRI-T 1W+FLAIR fusion, 14 cases of MRI-T 1W+fMRI-BOLD fusion, 13 cases of MRI-T 1W+DTI fusion, 5 cases of MRI-T 1W+fMRI-BOLD+DTI fusion, 2 cases of MRI-T 1W+FLAIR+fMRI-BOLD+DTI fusion. Results The lesions were completely resected in 38 cases (79.2%), subtotally resected in 5 cases (10.4%), partially resected in 2 cases, and biopsy in 1 case. One month after operation Karnofsky prognosis scale (KPS) demonstrated 90~100 in 35 cases (72.9%), and 1 case of death(2.1%). 2 patients(4.2%)suffered postoperative disability (KPS=40). Conclusions The multi-merged images in neuronavigation surgery can offer not only more detailed information about macroscopic structure and anatomy, but also spatial evaluation of various biophysical and biochemical processes in brain tissue. In addition, multi-image-merged neuronavigation should be determined for designing individual and optimal operative projection. Furthermore, to integrate different images into traditional neuronavigation images during surgery, was valuable in mapping topographical margins of lesion itself and characteristics of neighboring anatomic and functional structures. It was demonstrated to be a safe, efficient, reliable implement in minimal invasive neurosurgery.

关 键 词：神经导航手术 融合技术 影像融合 临床应用价值 功能神经外科 2002年 2001年 大脑半球 次全切除 部分切除 影像信息 精确定位 毗邻关系 功能结构 功能区 MRI 优良率 个体化 最优化 小创伤 病灶 

分 类 号：R651.1[医药卫生—外科学]