多模态影像三维重建结合面神经追踪技术在听神经瘤切除术中的应用研究  

Multimodal image three-dimensional reconstruction combined with facial nerve tracking in acousticneuroma surgery

作　　者：邱俊 李新军 易勇[3] 江竟成 王瀚 张超[3] 尹万红[1] Qiu Jun;Li Xinjun;Yi Yong;Jiang Jingcheng;Wang Han;Zhang Chao;Yin Wanhong(Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610000,China;Department of Neurosurgery,People's Hospital of Zhongjiang County,Deyang 618000,China;Department of Neurosurgery,Yibin Hospital,West China Hospital,Sichuan University,Yibin 644000,China)

机构地区：[1]四川大学华西医院重症医学科,成都610000 [2]中江县人民医院神经外科,德阳618000 [3]四川大学华西医院宜宾医院神经外科,宜宾644000

出　　处：《中华神经医学杂志》2023年第3期255-260,共6页Chinese Journal of Neuromedicine

基　　金：德阳市科技计划重点研发项目(2021SZZ061)。

摘　　要：目的探讨多模态影像三维重建结合面神经追踪技术在听神经瘤切除术中的应用价值。方法选择四川大学华西医院宜宾医院神经外科自2018年11月至2022年6月初次手术治疗的45例单发听神经瘤患者为研究对象, 术前利用多模态影像三维重建结合面神经追踪技术, 重建头皮、颅骨、脑组织、动静脉系统、肿瘤及面神经, 根据肿瘤与周围结构的关系进行术前规划。通过术中显微镜下所见和神经电生理监测结果共同评价面神经追踪的准确性。术后2周按House-Brackmann(H-B)标准评估患者面神经功能分级。术后3个月全部患者行MRI增强扫描, 结合术中所见, 判断肿瘤的切除程度。结果 45例患者均成功追踪出面神经走行, 经过术中显微镜下观察及神经电生理监测显示, 走行相符42例, 不相符3例。以术中神经电生理监测结果作为金标准, 多模态影像三维重建面神经的准确率为93.3%。术前多模态影像三维重建结合面神经追踪与术中神经电生理监测结果的一致性较高(Kappa=0.903, P<0.001)。术中面神经解剖保留率为91.1%(41/45), 术后2周面神经功能良好率为86.7%(39/45)。肿瘤全切除/近全切除率为88.9%(40/45)。所有患者在围手术期间均无死亡, 无脑脊液漏、术区血肿、脑梗死发生。结论应用多模态影像三维重建结合面神经追踪技术辅助听神经瘤切除术, 有助于更好地保护血管和神经, 提高肿瘤全切除率和面神经功能保留率。Objective To investigate the application value of multimodal image threedimensional reconstruction combined with facial nerve tracking in acoustic neuroma surgery.Methods Forty-five patients with single acoustic neuroma accepted primary surgical treatment at Department of Neurosurgery,Yibin Hospital,West China Hospital,Sichuan University from November 2018 to June 2022 were chosen.The head,skull,brain tissues,arteriovenous system,tumor and facial nerves were reconstructed preoperatively by multimodal three-dimensional image reconstruction combined with facial nerve tracking.Preoperative planning was carried out according to the relationship between tumor and surrounding structures.The accuracy of facial nerve tracking was evaluated by intraoperative microscopic observation and nerve electrophysiological monitoring.House-Brackmann(H-B)criteria was used to evaluate facial nerve functions 2 weeks after surgery.Three months after surgery,all patients underwent enhanced MRI scanning,and combined with intraoperative findings,the degrees of acoustic neuroma resection were determined.ResultsThe facial nerves and their relations with acoustic neuroma were successfully tracked in all 45 patients;as confirmed by intraoperative microscopy and nerve electrophysiological monitoring,the results of facial nerves and their relations with acoustic neuroma were consistent in 42 patients and inconsistent in 3 patients.Using intraoperative nerve electrophysiological monitoring as gold standard,the accuracy of multimodal image three-dimensional reconstruction of the facial nerves was 93.3%.Preoperative facial nerve tracking results were highly consistent with intraoperative nerve electrophysiological monitoring results(Kappa=0.903,P<0.001).The facial nerves were intraoperatively preserved in 91.1%patients(41/45),and the facial nerve function was good in 86.7%patients(39/45)at 2 weeks after surgery.The total/subtotal resection rate of acoustic neuroma was 88.9%(40/45).No death,cerebrospinal fluid leakage,hematoma,or cerebral infarction

关 键 词：多模态影像 三维重建 听神经瘤 面神经追踪 

分 类 号：R739.4[医药卫生—肿瘤]