影像融合及颅内电极三维重建在癫痫术前计划中的应用  

Value of MRI and CT images co-registration and three-dimensional visualization of intracranial electrodes to presurgical planning for epilepsy surgery

作　　者：黄河[1] 杜浩[1] 吕丽辉[1] 宋健[1] 黄成[1] 何远志[1] 孙荣辉[1] 丁慧超[1] 黄玲玥[1] 徐国政[1] 马廉亭[1] 

机构地区：[1]广州军区武汉总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2015年第12期705-708,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨影像融合及颅内电极三维重建在癫痫术前计划中的应用价值。方法对于行开颅颅内电极植入术以进行慢性皮层脑电评估的癫痫患者,获取其术前MRI及电极植入术后CT的影像资料,利用Synergy Cranial软件将两种影像进行融合,并对颅内电极、脑表面及颅骨进行三维重建,以显示出颅内电极与骨窗、脑表面的相对位置,为致痫灶的定位及下一步手术计划的制定提供准确的解剖信息。结果在2015年4月至8月共对10例需慢性皮层脑电监测的癫痫患者进行了开颅颅内电极植入术。通过术前MRI与电极植入术后CT影像融合技术,可以在MRI断层图像上观察到皮层电极中各触点与脑沟、脑回的相对平面位置,克服了术后无法行MRI检查的弊端。通过对影像融合后的颅内电极、脑表面及颅骨进行三维模型重建,可以立体直观地观察到颅内电极与脑表面和骨窗的相对空间位置,电极触点的重建成功率达90%。根据重建出的三维融合影像,结合皮层脑电图的监测结果,划定出致痫灶的位置与范围,制定手术计划,进行致痫灶切除术,术后所有患者均取得了良好效果。结论在对行颅内电极监测的癫痫患者制定手术计划时,利用影像融合和颅内电极三维重建技术,可以获得更为准确且直观的致痫灶定位信息,有利于提高致痫灶切除术的准确性和安全性。Objective To discuss the value of MRI and CT images co-registration and three-dimensional （3D-） visualization of intracranial electrodes to the presurgical planning for epileptic surgery. Methods MRI examination before the implantation of the intracranial electrodes （ICE） and CT examination after the implantation of ICE were performed in l0 patients with epilepsy in whom the cortical electrogram was evaluated by the ICE. Both the MRI and CT images were co-registered by the Synergy Cranial software, and 3D-visualization of the relative positions of ICE to the cerebral surface and cranial bone was performed in all the patients in order to provide the information for accurate location of the epileptogenic foci, which were resected by surgery. Results The relative positions of ICE discs to the cerebral sulci and gyri were visualized clearly on the images after MRI and CT images co-registration techniques. The view of distribution of electrodes on the brain surface was stereoscopically displayed by the 3D-models built by the co-registrated images, and the successful rate of ICE discs visualization was 90%. Based on the three dimensional models combined with the results of the cortical eletrogram, the zone of the epileptogenic foci were delineated in all the patients, who were treated by epileptic surgery. There were good curative effects in all the patients. Conclusions The MRI and CT images co-registration techniques and three-dimensional visualization of ICE may help to accurately locate the epileptogenic foci, and enhance the curative effect and safety of the epilepsy surgery in the patients with epilepsy.

关 键 词：癫痫 外科治疗 影像融合 三维重建 颅内电极 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]