3D Slicer在有框架脑立体定向活组织检查术中的应用  

Application of the 3D Slicer software in frame-based stereotactic brain biopsy

作　　者：刘鹏弟 张熙[1] 屈建强[1] 周乐[1] 权俊杰[1] 常健 闫先侠 Liu Pengdi;Zhang Xi;Qu Jianqiang;Zhou Le;Quan Junjie;Chang Jian;Yan Xianxia(Department of Neurosurgery,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China)

机构地区：[1]西安交通大学第二附属医院神经外科,西安710004

出　　处：《中华神经外科杂志》2022年第11期1120-1124,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金青年科学基金(81801121);陕西省资源主导型产业关键技术(链)项目(2016KTCL03-08)。

摘　　要：目的探讨3D Slicer软件在有框架脑立体定向活组织检查(简称活检)术中的应用价值。方法前瞻性纳入2019年11月至2021年12月于西安交通大学第二附属医院神经外科诊断为颅内占位并行有框架脑立体定向活检术的患者。所有患者术前均利用3D Slicer软件将头颅CT、MRI等多种影像学资料进行多模态配准,重建颅内占位病灶、血管、脑室及脑组织,在三维视窗展示其空间位置关系;设定靶点并计算靶点坐标,模拟最佳的穿刺路径,并根据模拟路径实施穿刺。术后复查头颅CT评估3D Slicer辅助活检取样的准确性和安全性。结果共纳入22例患者,所有患者3D Slicer重建效果均良好,病灶、血管、脑室、脑沟、脑回显示清晰。根据病灶位置设计穿刺靶点,22例患者中,穿刺靶点定位在额叶者8例、基底核区6例,顶枕区3例、颞叶2例、近侧脑室后角2例、鞍区1例。所有患者均按术前模拟穿刺路径顺利完成手术,术后复查头颅CT显示所有活检取样部位均位于病灶内,取样部位与预设靶点位置均吻合。术后患者均无出血、感染及新发神经功能障碍。术后病理学证实脑胶质瘤11例、淋巴瘤3例、脱髓鞘病变2例、转移性腺瘤2例、生殖细胞瘤1例、室管膜瘤1例、颅咽管瘤1例、坏死性炎性反应1例。结论3D Slicer能够保障有框架脑立体定向活检术穿刺位置的准确性和穿刺路径的安全性,降低手术风险。Objective To explore the application value of open-source 3D slicer in frame-based stereotactic brain biopsy(SBB).Methods Patients who were diagnosed with intracranial space-occupying lesions and underwent frame-based SBB at the Neurosurgery Department of the Second Affiliated Hospital of Xi′an Jiaotong University from November 2019 to December 2021 were prospectively enrolled.Before operation,3D Slicer were used for all the patients to perform multi-modal registration of medical images such as CT and MRI.Intracranial lesions,vessels,ventricles,as well as brain tissues were reconstructed and fully displayed in a three-dimensional window.Then the target within the lesion was preset and its three-dimensional coordinates were calculated.The optimal puncture path was simulated and the SBB was performed according to this predefined trajectory.The accuracy and safety of 3D slicer assisted SBB were evaluated by postoperative CT.Results A total of 22 patients were included in this study.The 3D reconstruction by 3D Slicer provided a good visualization for intracranial lesions,vessels,ventricles,sulci and gyri in all the included patients.The puncture target was designed according to the location of the lesion.Among the 22 patients,the targets were preset in the frontal lobe in 8 cases,the basal ganglia and thalamus in 6 cases,the parietooccipital lobe in 3 cases,the temporal lobe in 2 cases,the area near posterior horn of the lateral ventricle in 2 cases,and the sellar region in 1 case.All the stereotactic brain biopsies were successfully completed according to the preoperative simulated puncture plans.Postoperative CT showed that all biopsy sampling sites were located in the lesion,and the sampling sites were consistent with the preset targets.Patients had no bleeding,infection or new neurological dysfunction.Postoperative pathological diagnosis revealed 11 gliomas,3 lymphomas,2 demyelinating lesions,2 metastatic adenoma,1 germ cell tumor,1 ependymoma,1 craniopharyngioma and 1 necrotic inflammation.Conclusion 3D Slicer

关 键 词：立体定位技术 活组织检查 针吸 脑疾病 3D Slicer 

分 类 号：R651[医药卫生—外科学]