iPlan Stereotaxy软件在原发性三叉神经痛显微血管减压术前评估中的应用  

Application of iPlan stereotaxy software in preoperative evaluation of microvascular decompression for primary trigeminal neuralgia

作　　者：苗兴路[1] 赵长地[1] 姜山[2] 于明圣[3] 李钊 王增光[4] Miao Xinglu;Zhao Changdi;Jiang Shan;Yu Mingsheng;Li Zhao;Wang Zengguang(Department of Neurosurgery,Jining No.1 People’s Hospital,Jining 272011,China;Department of Radiology,Jining No.1 People’s Hospital,Jining 272011,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]济宁市第一人民医院神经外科,济宁272011 [2]济宁市第一人民医院放射科,济宁272011 [3]天津市环湖医院神经外科,天津300350 [4]天津医科大学总医院神经外科,天津300052

出　　处：《中华实验外科杂志》2023年第10期2085-2089,共5页Chinese Journal of Experimental Surgery

基　　金：国家重点研发计划(2022YFF1202500,2022YFF1202503);天津市重点研发计划科技支撑重点项目(20YFZCSY00010)。

摘　　要：目的探讨具有多模态影像融合三维重建功能的iPlan Stereotaxy软件在原发性三叉神经痛(PTN)显微血管减压(MVD)术前评估中的准确性。方法分析从2021年5月至2022年3月在济宁市第一人民医院行MVD治疗的PTN患者共54例,所有患者术前均完善颅脑三维可变翻转角快速自旋回波和三维时间飞跃磁共振血管成像序列扫描,将扫描数据导入iPlan Stereotaxy软件进行影像配准融合并重建出患者的血管、三叉神经和脑干三维立体影像,根据重建的三维立体影像,对责任血管类型和神经血管关系进行术前评估。最后,以术中对责任血管类型和神经血管关系的探查结果为金标准,采用Kappa检验判断术前评估结果与术中探查结果的一致性。结果iPlan Stereotaxy软件重建的三维立体影像在术前评估责任血管类别以及责任血管与三叉神经的接触位置、接触方向和接触程度方面,与术中探查结果比较具有高度的一致性,Kappa值分别是0.923、0.878、0.946和0.841,P均<0.01。结论术前应用iPlan Stereotaxy软件进行MVD术前评估的结果与术中探查结果高度一致,可用于制定手术计划和指导手术操作。Objective To explore the accuracy of iPlan Stereotaxy software with multimodal image fusion and three-dimensional reconstruction function in the preoperative evaluation of microvascular decompression(MVD)for primary trigeminal neuralgia(PTN).Methods This study retrospectively analyzed 54 patients collected from Jining No.1 People’s Hospital,May 2021 to March 2022,who underwent with MVD for PTN.All patients included in the study underwent a preoperative MRI with three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions sequence and three-dimensional time of flight magnetic resonance angiography sequence in combination.The MRI scan data were imported into iPlan Stereotaxy software for image registration and fusion.Then,the software was used to reconstruct three-dimensional images of the blood vessels,bilateral trigeminal nerves,and brainstem of the patients.According to the reconstructed three-dimensional images,the type of offending vessels and the neurovascular relationship were evaluated preoperatively.Finally,taking the intraoperative explorations of the type of offending vessels and the neurovascular relationship as the gold standard.Kappa coefficient was used to test the consistency between the preoperative evaluations and the intraoperative findings.Results The preoperative evaluations and intraoperative findings were substantial consistency in evaluating the type of offending vessels and the position,direction and degree of neurovascular contact,the Kappa values were 0.923,0.878,0.946,0.841 respectively,all P<0.01.Conclusion The results of preoperative MVD evaluation using iPlan Stereotaxy software are highly consistent with the results of intraoperative exploration of MVD,and can be used to develop surgical plans and guide operative procedures.

关 键 词：三叉神经痛 显微血管减压术 计算机辅助三维成像 神经血管关系 

分 类 号：R651.3[医药卫生—外科学]