多模态全息影像技术辅助中央区脑膜瘤手术切除的应用价值  

Multimodal holography-assisted surgical resection of meningioma in the central region

作　　者：杨吉鹏[1] 王同聚 卢圣奎[1] 宋燕飞 刘洪亮 孙晓枫[1] 霍浩然[1] 杨悦[1] 郭丽斯 李琛[1] YANG Jipeng;WANG Tongju;LU Shengkui(Department of Neurosurgery,the Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China;不详)

机构地区：[1]河北医科大学第二医院神经外科,石家庄市050000 [2]河北省临城县人民医院外四科 [3]石家庄平安医院神经外科

出　　处：《河北医药》2024年第9期1305-1310,共6页Hebei Medical Journal

基　　金：河北省重点研发计划项目-民生科技专项(编号:19277723D);河北省重点科技研究计划(编号:20221021)。

摘　　要：目的探讨多模态全息影像技术在中央区脑膜手术治疗中的应用价值。方法选取2021年6月至2022年10月神经外科收治的中央区脑膜瘤患者13例作为观察组,其中镰旁脑膜瘤2例,镰旁窦旁脑膜瘤6例,凸面脑膜瘤5例。术前完善颅脑CT、磁共振等影像学检查,利用3DSlicer、Matlab与Dsi Studio等软件建立颅骨、肿瘤、大脑皮层与上矢状窦的三维影像,参考三维全息影像制术前定个体化的手术方案、术中协助肿瘤定位并辅助13例中央区脑膜瘤的手术切除。选取2020年1月至2021年5月治疗的中央区脑膜瘤患者15例为对照组,比较2组患者术后1周肢体肌力的差异。结果术中采用弧形切口3例,马蹄形切口10例,肿瘤均定位准确;术中证实肿瘤与静脉及脑皮层的实际位置关系与术前重建影像均完全吻合;13例肿瘤SimpsonⅠ级切除8例,SimpsonⅡ级切除5例。术后1周肢体肌力正常11例,对侧上肢肌力Ⅲ级1例,对侧下肢肌力Ⅳ级1例,分别于术后第4周及第2~3周肌力恢复正常,复查颅脑CT出现脑水肿1例,术后平均住院时间(10.23±0.42)d。对照组患者术后1周肢体肌力正常5例,对侧下肢肌力Ⅳ级6例,对侧肢体肌力Ⅲ级4例,复查头颅脑CT出现脑水肿7例,术后平均住院(14.07±0.92)d,2组患者术后1周肌力、脑水肿情况及术后平均住院天数比较,差异均有统计学意义(P<0.05)。结论多模态全息影像技术可有效辅助中央区脑膜瘤手术方案的制定及肿瘤的精准定位,有助于术中上引流静脉与功能区大脑皮层的保护,减少手术副损伤。Objective To investigate the application value of multimodal holographic imaging technique in surgical removal of meningioma in the central region.Methods Thirteen patients with central region meningiomas admitted into the neurosurgery department from June 2021 to October 2022 were selected as observation group.There were 2 cases of parafalcine meningiomas,6 cases of parasagittal and parafalcine meningiomas,and 5 cases of convexity meningiomas.Preoperatively,computed tomography(CT)and magnetic resonance imaging(MRI)were performed in 13 patients.The three-dimensional models of skull,tumor,cerebral cortex and superior sagittal sinus were made using 3DSlicer,Matlab and Dsi Studio softwares.Under the assistance of holography,the surgical plans were achieved preoperatively and the 13 cases of meningiomas were removed during surgeries.Patients with meningiomas in the central region treated by the same surgeon from January 2020 to May 2021 were selected as the control group.Limb muscle strength 1 week postoperatively was compared between groups.Results In observation group,the curved incisions were made in 3 cases and horseshoe incision were applied in 10 cases during operations.The localizations of all the tumors in 13 cases were exact.The positional relationship of tumor,veins and cerebral cortex was confirmed intraoperatively,which was consistent completely with preoperative reconstructed holography.Eight patients underwent Simpson GradeⅠresection and five received Simpson GradeⅡresection.One week after surgery,normal limb muscle strength was detected in 11 cases.One case developed contralateral upper limb muscle strength of gradeⅢand recovered normal 4 weeks postoperatively.One case suffered from contralateral lower limb muscle strength of gradeⅣand recovered normal 2-3 weeks postoperatively.One case of cerebral edema was observed during re-examination of cranial CT.The average postoperative hospital stay was 10.23±0.42 days.In the control group,five patients had normal limb muscle strength one week postope

关 键 词：脑膜瘤 中央区镰旁脑膜瘤 上矢状窦 显微手术 

分 类 号：R739.41[医药卫生—肿瘤]