神经血管三维重建在术前诊断VBD合并HFS患者神经血管关系和责任血管中的应用  

Neurovascular three-dimensional reconstruction in preoperative diagnosis of neurovascular relations and offending arteries in patients with vertebrobasilar dolichoectasia complicated with hemifacial spasm

作　　者：石海亮[1] 李洋[1] 郭文昌 都毅辉 史皓威[1] 钱涛[1] Shi Hailiang;Li Yang;Guo Wenchang;Du Yihui;Shi Haowei;Qian Tao(Unite One,Department of Neurosurgery,Hebei General Hospital,Shijiazhuang 050057,China)

机构地区：[1]河北省人民医院神经外一科,石家庄050057

出　　处：《中华神经医学杂志》2020年第12期1194-1199,共6页Chinese Journal of Neuromedicine

基　　金：河北省政府资助专科能力建设和专科带头人培养项目(361003)。

摘　　要：目的探讨使用3D-slicer软件对神经血管进行三维同步重建在椎基底动脉扩张延长症(VBD)合并面肌痉挛(HFS)患者术前诊断神经血管关系和责任血管中的应用价值。方法选择河北省人民医院神经外一科自2016年1月至2019年2月行显微血管减压术(MVD)治疗的42例VBD合并HFS患者,术前将患者头颅三维时间飞跃法MRI血管成像(3D-TOF MRA)、三维稳态进动平衡序列(3D-FIESTA)MRI检查数据导入3D-slicer软件,对患者的血管、脑干、面听神经进行三维建模,比较3D-TOF MRA联合3D-FIESTA MRI检查、三维模型诊断患者神经血管关系和责任血管与术中所见的差异。结果术中所见与三维模型显示的神经血管关系、责任血管一致性均较好(Kappa=0.889,P=0.000;Kappa=0.869,P=0.000)。3D-TOF MRA联合3D-FIESTA MRI检查与三维模型显示的神经血管关系一致性较好(Kappa=0.809,P=0.000),二者诊断神经血管关系结果的差异无统计学意义(McN-B=5.000,P=0.082)。3D-TOF MRA联合3D-FIESTA MRI检查与三维模型显示的责任血管一致性差(Kappa=0.336,P=0.000),二者诊断责任血管结果的差异有统计学意义(McN-B=23.000,P=0.000)。结论应用3D-slicer软件对VBD合并HFS患者桥小脑角(CPA)区血管、神经及脑干进行三维重建,结果与术中所见高度一致。与3D-TOF MRA联合3D-FIESTA MRI检查比较,其对患者责任血管的确认、手术风险评估和手术策略的制定更有帮助。Objective To explore the application value of neurovascular three-dimensional(3D)reconstruction with 3D-slicer software in the preoperative diagnosis of neurovascular relations and offending arteries in patients with vertebrobasilar dilatation(VBD)complicated with facial muscle spasm(HFS).Methods The clinical data of 42 patients with VBD complicated with HFS accepted microvascular decompression(MVD)in our hospital from January 2016 to February 2019 were retrospectively analyzed.The data of skull 3D-TOF MR angiography and 3D-FiESTA MR imaging were imported into 3D-slicer software to establish 3D models of the blood vessels,brain stem and facial auditory nerves of the patients before surgery.The neurovascular relations and offending arteries found during surgery were compared with those diagnosed by 3D-TOF MR angiography combined with 3D-FiESTA MR imaging and 3D models.Results The consistencies of neurovascular relations and offending arteries found during surgery and those showed by 3D models were good(Kappa=0.889,P=0.000;Kappa=0.869,P=0.000).The consistency of neurovascular relations showed by 3D models and those diagnosed by 3D-TOF MR angiography combined with 3D-FiESTA MR imaging was good(Kappa=0.809,P=0.000);there was no significant difference between the two methods in diagnosing neurovascular relations(McNemar-Bowker=5.000,P=0.082).The consistency of offending arteries showed by 3D models and those diagnosed by 3D-TOF MR angiography combined with 3D-FiESTA MR imaging was poor(Kappa=0.336,P=0.000);there was significant difference between the two methods in diagnosing offending arteries(McNemar-Bowker=23.000,P=0.000).Conclusion The 3D-slicer software is used to perform 3D simultaneous reconstruction of blood vessels,nerves and brain stem in the cerebellopontine angle,and the results are highly consistent with surgical findings;3D-slicer software is more helpful than 3D-TOF MR angiography combined with 3D-FiESTA MR imaging in identification of offending arteries,surgical risk assessment and surgical strategy fo

关 键 词：面肌痉挛 椎基底动脉扩张延长症 三维重建 

分 类 号：R651[医药卫生—外科学]