3D Slicer三维影像重建技术在显微血管减压术治疗原发性三叉神经痛中的应用  

Application of 3D image reconstruction using 3D Slicer software in microvascular decompression for patients with primary trigeminal neuralgia

作　　者：单明[1] 王毅[1] 吕波[1] 毛宏亮 程宏伟[1] SHAN Ming;WANG Yi;LÜBo;MAO Hong-liang;CHENG Hong-wei(Department of Neurosurgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022

出　　处：《中国临床神经外科杂志》2024年第2期65-69,共5页Chinese Journal of Clinical Neurosurgery

基　　金：安徽省自然科学基金(2208085MH224)。

摘　　要：目的探讨3D Slicer三维影像重建技术在显微血管减压术(MVD)治疗原发性三叉神经痛(PTN)中的应用价值。方法回顾性分析2020年1月至2022年12月MVD治疗的56例PTN的临床资料。术前行3D-TOF-MRA、3D-FIESTA扫描,并应用3D Slicer软件进行三维影像重建,了解血管与神经的关系、责任血管走行并模拟手术;术中显微镜下不能充分暴露或操作困难时,应用神经内镜进行观察及操作。结果55例术中确认存在责任血管,其中12例在神经内镜下确认;1例术中未发现责任血管。53例术前三维重建影像发现的责任血管与术中发现一致;3例术前三维重建影像为阴性,包括术中证实为静脉压迫2例、未发现责任血管1例。42例术后疼痛即刻消失,明显减轻13例,无变化1例。术后出现面部麻木4例、口周疱疹1例,对症治疗后缓解。术后随访15~47个月,BNI疼痛分级Ⅰ~Ⅱ级53例,Ⅲ级2例,Ⅳ级1例;有效率为94.6%。结论应用MVD治疗PTN时,3D Slicer三维影像重建技术有助于术前明确责任血管及其走行,可模拟手术以优化手术规划,减少术中不必要的探查与牵拉。神经内镜可弥补显微镜视野盲区,有助于暴露责任血管,减少责任血管遗漏,并可辅助确认及调整棉片的位置,提高手术效果。Objective To investigate the application value of three-dimensional(3D)image reconstruction in microvascular decompression(MVD)for primary trigeminal neuralgia(PTN).Methods A retrospective analysis was conducted on the clinical data of 56 patients with PTN who underwent MVD from January 2020 to December 2022.Pre-operatively,3D-TOF-MRA and 3D-FIESTA scans were performed,and the 3D Slicer software was used for 3D image reconstruction to understand the relationship between vessels and nerves,identify the running course of responsible vessels,and simulate the surgery.An endoscope was used during surgery when the responsible vessels were not fully exposed under a microscope.Results The responsible vessele were confirmed during surgery in 55 patients,of whom 12 were confirmed by endoscope,and no responsible vessels were found in one case during surgery.The responsible vessels identified by the preoperative 3D reconstruction images was consistent with those found during surgery in 53 patients.The preoperative 3D reconstruction images were negative in 3 patients,including 2 patients confirmed as vein compression during surgery and 1 without finding the responsible vessel.The pain disappeared immediately in 42 patients after surgery,significantly improved in 13,and did not change in 1.Postoperative facial numbness occurred in 4 patients and herpes zoster in 1,which were improved after symptomatic treatment.The follow-up ranged from 15 months to 47 months.The BNI gradeⅠ~Ⅱwas achieved in 53 patients,gradeⅢin 2,and gradeⅣin 1.The effective rate was 94.6%.Conclusions For patients with PTN undergoing MVD,3D image reconstruction using 3D Slicer software can assist in pre-operative clarification of the responsible vessels and their running course,which can simulate surgery to optimize surgical planning and reduce unnecessary exploration and traction during surgery.The endoscope can complement the blind area of the microscope and help expose the responsible vessels,reducing the risk of missing responsible vessels,and can

关 键 词：原发性三叉神经痛 显微血管减压术 3D-TOF-MRA 3D-FIESTA 3D Slicer三维重建技术 神经内镜 

分 类 号：R745.11[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]