双倍剂量三维磁共振增强扫描在神经外科立体定向手术机器人辅助颅内电极植入术中的应用  

Application of double-dose 3D-MR enhanced scanning in ROSA assisted intracranial electrode implantation

作　　者：张德华 龚德山 张俊祥 沈衍超 Zhang Dehua;Gong Deshan;Zhang Junxiang;Shen Yanchao(Department of Radiology,Shanghai RICH Daffodil Women's and Children's Hospital,shanghai 200040 China;不详)

机构地区：[1]上海瑞慈水仙妇儿医院放射科,200040 [2]上海德济医院神经外科 [3]上海德济医院放射科

出　　处：《实用医学影像杂志》2021年第5期508-511,共4页Journal of Practical Medical Imaging

摘　　要：目的探讨双倍剂量三维磁共振(3D-MR)增强扫描在立体定向手术机器人(ROSA)辅助颅内电极植入术中避免脑皮层静脉受压或损伤的应用价值。方法90例癫痫患者行ROSA辅助电极植入术前接受脑双倍剂量3D-MR增强扫描,利用后处理工作站对MR图像进行静脉血管重建及融合后处理,ROSA辅助植入电极时利用后处理图像,在手术路径上避开脑皮层静脉。结果依靠双倍剂量3D-MR增强扫描后处理图像导航,ROSA辅助下颅内电极植入术90例患者中,硬膜下血肿伴蛛网膜下腔积血2例,单纯硬膜下血肿3例,单纯蛛网膜下腔积血4例,脑实质小血肿1例,颅内积气19例。仅1例硬膜下血肿1 d后复查范围扩大并行血肿清除术。所有患者除1例因硬膜下血肿扩大行血肿清除术,及植入电极位置调整外,其余病例在术后动态脑电图监测中均未出现脑电监测信号弱、不稳定等异常。结论双倍剂量3D-MR增强扫描后处理重建脑皮层静脉融合图像,可有效指导ROSA辅助脑电极植入路径,避免脑皮层静脉血管受压或损伤。Objective To investigate the application value of double-dose 3D-MR enhanced scanning in robot of stereotactic a ssitant(ROSA)assisted intracranial electrode implantation to avoid cerebral venous compression or injury.Methods Ninty patients with epilepsy received double-dose 3D-MR enhanced brain scan before ROSA assisted electrode implantation,and used post-processing workstation to reconstruct and fuse MR images.ROSA assisted electrode implantation used post-processing images to avoid cerebral cortical veins in the surgical path.Results In 90 patients,subdural hematoma with subarachnoid hematoma in 2 cases,subdural hematoma only 3 cases,subarachnoid hematoma only 4 cases,small brain parenchyma hematoma only 1 case,intracranial pneumatosis in 19 cases.Only 1 case of subdural hematoma was reexamined after 1 day with expanded range and hematoma removal.Except for 1 patient who underwent hematoma removal due to subdural hematoma enlargement and adjustment of implanted electrode position,no abnormal eeg monitoring signals such as weak and unstable were found in the other patients in the postoperative dynamic eeg monitoring.Conclusion After the double-dose 3D-MR enhanced scanning,the cortical vein fusion images were reconstructed,which could effectively guide ROSA assisted brain electrode implantation pathway and avoid the cerebral cortical vein compression or injury.

关 键 词：双倍剂量 3D-MR增强扫描 图像后处理 ROSA辅助电极植入 脑皮层 静脉损伤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651[医药卫生—诊断学]