混合现实技术在前床突脑膜瘤手术治疗中的应用  

Application of mixed reality technology in surgical treatment of anterior clinoidal meningioma

作　　者：贾景元 杨吉鹏[1] 任洪波[2] 张丽巧 李琛[1] 李朝晖[1] 刘晓鹏[1] 胡红超[1] 杨悦[1] 孙晓枫[1] Jia Jingyuan;Yang Jipeng;Ren Hongbo;Zhang Liqiao;Li Chen;Li Zhaohui;Liu Xiaopeng;Hu Hongchao;Yang Yue;Sun Xiaofeng(Department of Neurosurgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Neurosurgery,Handan Central Hospital,Handan 056001,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]邯郸市中心医院神经外科,河北056001

出　　处：《中华神经外科杂志》2021年第11期1114-1118,共5页Chinese Journal of Neurosurgery

基　　金：河北省重点研发计划项目-民生科技专项(20377703D);河北省科技厅-河北医科大学“厅校会商基金-科技创新”项目(2020TXJC03)。

摘　　要：目的探讨混合现实(MR)技术在前床突脑膜瘤手术治疗中的应用价值。方法回顾性分析2020年10月至2021年7月河北医科大学第二医院神经外科收治的11例前床突脑膜瘤患者的临床资料。术前对所有患者行头颅CT、MRI、弥散张量成像(DTI)及磁共振血管成像(MRA)检查,采用3D-Slicer软件构建三维模型并应用MR技术全息呈现,从而判断肿瘤与周围重要血管、神经的位置关系,制定个体化的手术策略。术后复查头颅MRI,判断肿瘤的切除程度;记录患者的肢体肌力、感觉、共济等神经功能及并发症。结果11例患者术前均成功构建三维模型,通过头戴式显示系统均可全息呈现。11例患者的肿瘤体积为(40485±24261)mm^(3)(5653~100140 mm^(3)),均明显挤压同侧视神经。9例患者的肿瘤包裹颈内动脉及其分叉部,其中2例成功构建穿支动脉、另7例未成功;2例患者的肿瘤单纯压迫或推挤颈内动脉及其属支,使其明显移位。11例患者的术中所见和手术操作均与术前手术策略相一致。术后复查头颅MRI显示,7例为肿瘤完全切除;另4例为次全切除,其中1例的肿瘤与其包绕的颈内动脉、大脑中动脉之间无明显蛛网膜界面,3例的肿瘤侵入海绵窦。术后无一例出现脑脊液漏。术后1周,患者的肢体肌力为,Ⅴ级6例,Ⅳ级4例,0级1例。4例患者的患侧存在轻度共济失调,3例视力较术前改善。结论MR技术在前床突脑膜瘤手术治疗前可辅助术者制定个性化的手术策略,减少术中对重要结构的损伤,并降低术后并发症的发生。Objective To explore the application value of mixed reality(MR)technology in the surgical treatment of anterior clinoidal meningioma.Methods The clinical data of 11 patients with anterior clinoidal meningioma admitted to the Department of Neurosurgery,the Second Hospital of Hebei Medical University from October 2020 to July 2021 were retrospectively analyzed.Before surgery,all patients were examined by head CT,MRI,diffusion tensor imaging(DTI)and magnetic resonance angiography(MRA),and 3D-Slicer software was used to construct a three-dimensional model,which could be presented holographically by applying MR technology,to determine the positional relationship between the tumor and the surrounding important blood vessels and nerves,and to fonnulate individualized surgical strategy.Postoperative head MRI was reviewed to determine the extent of tumor resection.The patient's limb muscle strength,sensation,coordination,other neurological functions and complications were documented.Results For all 11 patients,a three-dimensional model was successfully constructed before the operation,which could be presented holographically through the head-mounted display system.The tumor volume of 11 patients was 40485±24261 mm^(3)(range:5653-100140 mm^(3)),all of which significantly squeezed the ipsilateral optic nerve.The tumors of 9 patients wrapped the internal carotid artery(ICA)and its bifurcations.Among them,the reconstruction of perforating arteries was successful in 2 cases but failed in the remaining 7 cases.The tumors of 2 patients simply compressed or pushed the ICA and its branch to make it obviously shifted.The intraoperative findings and surgical operations of 11 patients were consistent with the preoperative surgical strategy.Postoperative head MRI showed that the tumor was completely removed in 7 cases.The other 4 cases had subtotal resection.Among them,there was no obvious arachnoid interface between the tumor and the surrounding ICA and middle cerebral artery in 1 case,and tumor invaded the cavernous sinus in 3 case

关 键 词：脑膜瘤 治疗结果 前床突 混合现实技术 多模态 

分 类 号：R739.45[医药卫生—肿瘤]