3D Slicer三维重建技术辅助手术治疗枕骨大孔区硬脑膜动静脉瘘:附1例报道并文献复习  

Surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for dural arteriovenous fistula in the foramen magnum: a case report and literature review

作　　者：崔昊 王奎重 王小刚 徐广振 王伯栋 朱伟杰 CUI Hao;WANG Kui-zhong;WANG Xiao-gang;XU Guang-zhen;WANG Bo-dong;ZHU Wei-jie(Weifang Medical College,Weifang 261053,China;Department of Neurosurgery,the 960th Hospital of Joint Logistic Support Force,Jinan 250031,China)

机构地区：[1]潍坊医学院临床医学院,山东潍坊261053 [2]联勤保障部队第九六〇医院神经外科,济南250031

出　　处：《中国临床神经外科杂志》2024年第2期84-87,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨枕骨大孔区硬脑膜动静脉瘘(DAVF)的影像学特征以及3D Slicer三维重建技术辅助手术治疗的疗效。方法回顾性分析2021年6月收治的1例枕骨大孔区DAVF的临床资料,并结合相关文献进行分析。结果50岁男性,因双下肢麻木及疼痛不适1个月入院。脊柱MRI显示延髓至颈5水平颈髓异常信号。双侧颈内动脉、双侧颈外动脉、右侧椎动脉造影未发现异常,左侧椎动脉造影显示枕骨大孔区DAVF,由脑膜后动脉多个分支供血,经小脑表面及数支硬脑膜迂曲扩张的皮质静脉引流汇入左侧横窦、岩上窦及基底窦,并可见迂曲的硬脊膜前、后静脉参与瘘口血液引流;左侧小脑后下动脉(PICA)靠近瘘口部位走行且迂曲。3D Slicer三维重建影像清晰显示DAVF的位置、供血动脉和引流静脉,多模态重建显示瘘口位于枕部后正中枕骨大孔上区域并靠近硬脑膜。采取枕颈部后正中入路手术,术中吲哚菁绿荧光造影确认DAVF消失。术后3个月,双下肢麻木及疼痛感均有减轻;复查MRI显示脑干和脊髓水肿消失,DSA显示DAVF完全闭塞。结论枕骨大孔区DAVF手术治疗可以显著改善病人预后,应用3D Slicer三维重建技术对DAVF进行精准定位能够在很大程度上节省手术时间并提高手术质量。Objective To investigate the imaging features of patients with dural arteriovenous fistula(DAVF)in the foramen magnum region and the efficacy of surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for such patients.Methods The clinical data of a patient with DAVF in the foramen magnum region admitted in June 2021 were retrospectively analyzed,and the relevant literatures were reviewed.Results A 50-year-old man was admitted to hospital due to numbness and pain in the lower limbs for 1 month.Spinal MRI showed abnormal signals of cervical spinal cord from medulla oblongata to the C5 spinal cord.Angiographies via bilateral internal carotid arteries,bilateral external carotid arteries,and the right vertebral artery showed no abnormalities,while angiography via the left vertebral artery showed DAVF in the foramen magnum region,which was supplied by multiple branches of the posterior meningeal artery,and drained into the left transverse sinus,suprapetrosal sinus,and basilar sinus through the severely tortuous dilated cortical veins of the dura mater.The tortuous anterior and posterior dural veins were involved in the blood drainage of the fistula.The left posterior inferior cerebellar artery(PICA)was running and tortuously near to the fistula.The three-dimensional reconstructed images using 3D Slicer software clearly showed the location of DAVF,the feeding arteries and draining veins,and multimodal reconstructed images showed that the fistula was located in the posterior median region of the occipital foramen magnum and close to the dura mater.The patient underwent microsurgery through posterior median approach,and intraoperative indocyanine green fluorescence angiography showed the disappearance of DAVF.Three months after operation,the numbness and pain in the lower limbs were relieved;reexamination of MRI showed that the edema of brainstem and spinal cord disappeared,and DSA showed complete occlusion of DAVF.Conclusions Surgical treatment of DAVF in the foramen magnum can

关 键 词：硬脑膜动静脉瘘 枕骨大孔区 手术治疗 3D Slicer三维重建技术 

分 类 号：R743[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]