混合现实技术在听神经瘤手术中的应用价值  

Clinical application of mixed reality technology in surgical resection of vestibular schwannomas

作　　者：杨吉鹏[1] 贾景元 卢圣奎[1] 吴艳凯[2] 宋登浩[2] 李琛[1] 李朝晖[1] 杨悦[1] 牛伟浩 孙晓枫[1] Yang Jipeng;Jia Jingyuan;Lu Shengkui;Wu Yankai;Song Denghao;Li Chen;Li Zhaohui;Yang Yue;Niu Weihao;Sun Xiaofeng(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)

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

出　　处：《中华神经外科杂志》2023年第1期35-40,共6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：目的探讨混合现实技术在听神经瘤手术中的应用价值。方法回顾性分析2021年1月至2022年2月于河北医科大学第二医院神经外科行手术治疗的25例听神经瘤患者的临床资料。患者术前均行颞骨CT、循环相位稳态采集快速成像和弥散张量成像等检查,利用3D-Slicer软件建立三维模型,并经混合现实技术呈现三维模型影像,预测肿瘤与面听神经的位置关系,从而制定个体化的手术方案。以术中神经电生理监测结果作为金标准,采用Kappa一致性检验评价术前重建面神经的走行与术中神经电生理监测定位的一致性。25例患者均经乙状窦后入路手术。术前及术后1周采用House-Brackmann分级评估患者的面神经功能。结果25例患者术前均成功重建听神经瘤三维模型,肿瘤重建后的中位体积为6.18 cm^(3)(0.73~16.86 cm^(3))。其中23例(92.0%)成功重建面神经,余2例重建失败。开颅时关键孔定位的满意率为96.0%(24/25),无静脉窦损伤的患者。术前成功重建面神经的23例患者中,20例与术中神经电生理监测定位的面神经完全一致,准确率为86.9%;Kappa一致性检验显示,术前重建面神经的走行与术中神经电生理监测定位具有较强的一致性(Kappa=0.836,P<0.01)。25例患者术后复查头颅MRI显示肿瘤均全切除,术后1周House-Brackmann分级Ⅰ级6例,Ⅱ级9例,Ⅲ级6例,Ⅳ级4例,无脑脊液漏患者。结论术前行混合现实技术重建三维模型可辅助听神经瘤的手术切除,有利于术中面神经的保护,减少手术的副损伤。Objective To investigate the application value of mixed reality technology in surgical resection for vestibular schwannomas(VS).Methods The clinical data of 25 patients with VS who underwent neurosurgery at the Department of Neurosurgery,the Second Hospital of Hebei Medical University from January 2021 to February 2022 were retrospectively analyzed.All patients underwent preoperative temporal bone CT,fast imaging employing steady-state acquisition with cycled phases,and diffusion tensor imaging.The 3D model was established using 3D-Slicer software,and the 3D model image was presented by mixed reality technology to predict the positional relationship between the tumor and the facial and auditory nerves,so as to develop an individualized surgical plan.Taking the results of intraoperative neurophysiological monitoring as the gold standard,the Kappa test was used to evaluate the consistency between the course of the preoperatively reconstructed facial nerve and the positioning of intraoperative neurophysiological monitoring.All 25 patients underwent surgery through the retrosigmoid approach.The facial nerve function of the patients was evaluated by House-Brackmann classification before operation and 1 week after operation.Results All 25 patients successfully underwent reconstruction of the three-dimensional model of VS before operation,and the median volume of the tumor after reconstruction was 6.18 cm^(3)(0.73-16.86 cm^(3)).Among them,facial nerve reconstruction was successful in 23 cases(92.0%),and reconstruction failed in 2 cases.The satisfaction rate of keyhole positioning during craniotomy was 96.0%(24/25),and there were no patients with venous sinus injury.Among the 23 patients who successfully underwent reconstruction of the facial nerve before operation,20 cases showed completely consistency between reconstruction results and the facial nerve positioning based on the intraoperative neurophysiological monitoring,and the accuracy rate was 86.9%.The Kappa test showed that there was a strong consistency between t

关 键 词：神经瘤 听 面神经 显微外科手术 治疗结果 混合现实 电生理学 

分 类 号：R739.41[医药卫生—肿瘤]