多模态神经导航结合显微镜下显影技术在大脑运动功能区肿瘤精准切除手术中的应用  

Application of Multimodal Neuronavigation Combined with Microscopic Imaging in Precise Resection of Brain Tumors in Motor Functional Areas

作　　者：李亚东 刘金昊[2] 线春明[1] 贺喜武[1] 卢忠胜[1] 杨鹏[1] 张强[1] LI Ya-dong;LIU Jin-hao;XIAN Chun-ming;HE Xi-wu;LU Zhong-sheng;YANG Peng;ZHANG Qiang(Department of Neurosurgery,Qinghai Provincial People's Hospital;Nuclear Magnetic Resonance Room,Qinghai Provincial People's Hospital,Xining 810007,P.R.C.)

机构地区：[1]青海省人民医院神经外科,西宁810007 [2]青海省人民医院核磁室,西宁810007

出　　处：《中国医学计算机成像杂志》2020年第3期291-296,共6页Chinese Computed Medical Imaging

基　　金：青海省卫生系统指导性计划课题2018-wjzdx-22。

摘　　要：目的:探讨多模态神经导航影像融合技术结合显微镜下显影在大脑运动功能区肿瘤手术中的临床应用价值。方法:回顾性分析19例肿瘤病变位于大脑运动功能区及邻近的患者,术前行磁共振弥散张量成像(DTI)及CTA、MRV等检查,经多模态影像融合软件重建,术中神经导航与显微镜进行数据连接,镜下实现功能区肿瘤位置及周围纤维束、载瘤动静脉三维可视化,术中操作可最大限度切除肿瘤,同时保护瘤周正常脑组织血供及纤维传导束。结果:术中均准确定位肿瘤边界,准确定位术前设计的入路脑沟,避免损伤功能区皮质及传导束。19例功能区肿瘤中,16例病变全切除,3例次全切除,无死亡和其他严重并发症。术后病理结果:神经胶质瘤7例(低级别5例,高级别2例),脑膜瘤12例。术后3个月复查,19例患者肢体肌力及感觉无减退或有改善,其中10例有明显改善。结论:神经多模态融合技术结合显微镜下显影可以准确定位功能区肿瘤边界,实现术中保护瘤周邻近传导束、功能区皮层和正常血管,在可视安全范围内最大程度地切除肿瘤,减少术后神经功能障碍,提高患者术后的生存及生活质量。Purpose:To explore the clinical value of multi-modality image fusion neuronavigation combined with microscopic imaging in the operation of tumors in the brain motor function area.Methods:Nineteen cases of brain tumor which located in or near the brain motor function area and underwent neurosurgery operation in Qinghai Provincial People's Hospital from March 2016 to March 2018 were retrospctive analyzed.All the cases had undergone with preoperative magnetic resonance diffusion tensor imaging(DTI)and CTA,MRV,and these image data were processed by multi modal image fusion software.The intraoperative neuronavigation system was connected with the microscope.The three-dimensional visualization of the tumor location,surrounding fiber bundles and the tumor-bearing arteries and veins was archieved under the microscope.The tumor could be removed to the maximum extent under this intraoperative operation.At the same time,the blood supply and fiber conduction bundle of normal brain tissue could be protected.Results:During the operation,the tumor boundaries were accurately located,and the sulcus designed before surgery was accurately located to avoid damage to the cortex and conduction bundle of the functional area.Of the 19 functional tumors,16 were completely resected,3 were subtotal,and there were no deaths or other serious complications.Postoperative pathological results:7 cases of glioma(5 cases of low grade,2 cases of high grade),12 cases of meningioma.Three months after the operation,19 patients were with no loss or improvement in limb muscle strength and sensation,and 10 of them with significant improvement.Conclusion:The multi-modal fusion technique combined with microscopic imaging can accurately locate the tumor boundary in the functional area,and realize the intraoperative protection of the adjacent pericardial conduction bundle,functional cortex and normal blood vessels,and maximally remove the tumor within the visual safety range.The postoperative neurological dysfunction can be reduced and postoperative survival

关 键 词：神经导航 弥散张量成像 神经肿瘤 显微外科手术 脑保护 

分 类 号：R445.2[医药卫生—影像医学与核医学]