虚拟内镜技术在分流失败脑积水中的诊治价值  

Value of virtual endoscopy in diagnosis and treatment for hydrocephalus after failed shunt

作　　者：宋志军[1,3] 唐运林 陈晓雷[3] 周连银 杜国方 易璐 杨璇 余新光[3] 周定标[3] 

机构地区：[1] 解放军第四五八医院神经外科,广州,510062 [2]解放军第四五八医院医务处,广州510062 [3]解放军总医院神经外科 [4]解放军75200部队门诊部

出　　处：《中华医学杂志》2015年第29期2359-2362,共4页National Medical Journal of China

摘　　要：目的 探讨虚拟内镜技术在分流失败的脑积水中的诊疗价值.方法 对2012年2月至2014年11月解放军总医院连续收治的76例,在其他医院分流失败的脑积水患者行三维快速自旋回波（3D-SPACE）序列扫描,根据3D-SPACE序列的DICOM数据采用3D-Slicer软件在个人电脑上进行三维重建虚拟内镜,依二者结果决定手术策略,评价虚拟内镜技术提供的信息对治疗策略的影响和临床价值.结果 在3D-SPACE基础上三维重建后的虚拟内镜图像对判断之前分流手术失败的原因和显示中脑导水管及室间孔梗阻有较大帮助.最终,共56例（73.7％）无需分流管而通过神经内镜治疗获得了脑积水的治愈.结论 虚拟内镜技术比常规磁共振影像能够提供更多的术前解剖影像信息,在分流失败的脑积水中有较好协助诊断价值,对决定手术策略亦能提供非常有价值的帮助.Objective To investigate the value of virtual endoscopy in diagnosis and treatment of hydrocephalus after failed shunt.Methods we performed magnetic resonance imaging （MRI） 3D-SPACE sequence scanning for 76 patients suffering from hydrocephalus after failed shunt.Based on the DICOM data of 3D-SPACE sequence,we three-dimensionally reconstructed the ventricles and simulated virtual endoscopy with 3D-Slicer software.Surgical strategy was made after evaluation of virtual endoscopy images.Results Virtual endoscopy based on 3D-SPACE images was helpful to depict the aqueduct or foramen of Monro obstructions,and confirm the reason of shunt failure.Finally,there were 56 hydrocephalus patients （73.7%） were treated with endoscopic assisted third ventricle fistula （ETV）,without shunt catheter insertion.Conclusion For patients suffering from shunt failure of hydrocephalus,virtual endoscopy has high diagnostic yield rate for providing more detailed anatomical information than conventional MR imaging.Hence,this advanced imaging method is helpful for surgical treatment strategy decision making.

关 键 词：脑积水 虚拟内镜 脑室腹膜分流术 脑室造口术 

分 类 号：R651.1[医药卫生—外科学]