3DSlicer软件辅助经对侧纵裂入路显微手术治疗镰旁脑膜瘤  

3DSlicer software assisted microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach

作　　者：杨吉鹏[1] 李晓瞳 王同聚 孙晓枫[1] 李朝晖[1] 胡红超[1] 李琛[1] Yang Jipeng;Li Xiaotong;Wang Tongju;Sun Xiaofeng;Li Zhaohui;Hu Hongchao;Li Chen(Department of Neurosurgery,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Radiology,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of General Practice,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经外科,石家庄050000 [2]河北医科大学第二医院医学影像科,石家庄050000 [3]河北省邢台市临城县人民医院外四科,054300

出　　处：《中国综合临床》2021年第5期420-425,共6页Clinical Medicine of China

基　　金：河北省重点研发计划项目-民生科技专项课题 (19277723D)。

摘　　要：目的评价利用3DSlicer软件辅助经对侧纵裂入路显微手术治疗镰旁脑膜瘤的效果。方法采用病例对照研究方法,选取2020年1月至2021年1月于河北医科大学第二医院诊治的镰旁脑膜瘤患者18例作为观察组,利用3DSlicer软件辅助并采取对侧纵裂入路显微手术治疗。术前完善头颅CT核磁平扫与强化、核磁动脉成像与核磁静脉成像等影像学检查,并利用3DSlicer软件建立肿瘤、上矢状窦、大脑上动脉等模型并分析肿瘤与上矢状窦及大脑上静脉的位置关系,采取对侧纵裂入路切除肿瘤。另选取2019年1—12月经传统同侧纵裂入路手术治疗的19例镰旁脑膜瘤患者为对照组。比较两组患者手术时间、术中出血量、术后1周肢体肌力恢复率与头痛、头晕缓解率方面的差异。结果观察组18例患者重建的肿瘤与其基底上方的大脑上静脉的位置关系与术中实际情况均完全一致,均行SimpsonⅠ级切除术,术中均无大脑上静脉及静脉窦损伤;观察组12例一侧下肢肌无力患者术后1周肢体肌力恢复9例,对照组13例一侧下肢肌无力患者术后1周肢体肌力恢复3例,两组比较差异有统计学意义(P=0.009),而观察组的手术时间、术中出血量与术后1周头痛、头晕缓解率比较差异均无统计学意义(P均>0.05)。结论应用3DSlicer软件可帮助术前评估镰旁脑膜瘤与大脑上静脉、上矢状窦等结构的位置关系,指导医师经对侧纵裂入路切除肿瘤,显著减少术中对大脑上静脉、功能区脑皮质等重要结构的副损伤,有助于患者肢体肌力的恢复。Objective To evaluate the effect of microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach assisted by 3DSlicer software.Methods From January 2020 to January 2021,18 patients with parafalcine meningioma in The second hospital of Hebei Medical University were randomly selected as the observation group.The contralateral longitudinal fissure was treated by microsurgery assisted by 3DSlicer software.Before operation,improve the imaging examinations such as brain CT plain and enhancement,magnetic resonance angiography and magnetic resonance venography,establish the models of tumor,superior sagittal sinus and superior cerebral artery by using 3DSlicer software,analyze the positional relationship between tumor and superior sagittal sinus and superior cerebral vein,and remove the tumor by contralateral longitudinal fissure approach.Nineteen patients with parafalx meningioma treated by traditional ipsilateral longitudinal fissure approach from January to December 2019 were selected as the control group.The differences in operation time,intraoperative bleeding,limb muscle strength recovery rate,headache and dizziness relief rate were compared between the two groups.Results In the observation group,the positional relationship between the reconstructed tumor and the superior cerebral vein above its base was completely consistent with the actual situation during the operation.All patients underwent Simpson grade I resection,and there was no injury to the superior cerebral vein and venous sinus during the operation.The recovery rate of limb muscle strength in the observation group(75%(9/12))was higher than that in the control group(23%(3/13))(P=0.009).There was no significant difference in the operation time,intraoperative bleeding and the remission rate of headache and dizziness one week after operation in the observation group(P>0.05).Conclusion 3DSlicer software was helpful for preoperative evaluation of the positional relationship between parafalcine meningioma and the anatomic structur

关 键 词：脑膜瘤 3DSlicer软件 显微手术 大脑镰旁 

分 类 号：R739.45[医药卫生—肿瘤]