3D Slicer三维重建技术在原发性面肌痉挛显微血管减压术前评估中的应用  

Application of 3D reconstruction technology using 3D Slicer software in pre-operative assessment of patients with primary hemifacial spasm undergoing microvascular decompression

作　　者：王强[1] 杨岸超[1] WANG Qiang;YANG An-chao(Department of Neurosurgery,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《中国临床神经外科杂志》2024年第5期257-260,共4页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(82302879)。

摘　　要：目的探讨3D Slicer三维重建技术在面肌痉挛(HFS)显微血管减压术(MVD)前评估中的应用价值。方法回顾性分析2022年6月至2023年12月MVD治疗的200例HFS的病例资料。术前均行3D-FIESTA和3D-TOF MRA检查,应用3D Slicer软件进行三维重建,指导MVD。以术中发现为金标准。结果除1例阴性外,术中发现责任血管199例,其中小脑前下动脉(AI-CA)111例,小脑后下动脉52例,椎动脉(VA)29例,AICA联合VA有7例。3D-FIESTA和3D-TOF MRA检查与术中发现一致性一般(κ值=0.326),敏感性、特异性和准确性分别为83.90%、100.00%和91.00%;3D Slicer三维重建技术与术中发现一致性良好(κ值=0.651),敏感性、特异性和准确性分别为99.00%、100.00%和100.00%。3D Slicer三维重建技术预测责任血管的效果明显优于3D-FIESTA和3D-TOF MRA检查(P<0.001)。200例术后随访6~24个月,中位随访时间为12个月,症状完全缓解142例(71.00%),部分缓解51例(25.50%),无变化7例(3.50%)。结论MVD治疗HFS术前应用3D Slicer软件根据3D-FIESTA和3D-TOF MRA检查数据进行三维重建,模拟手术路径,可以降低遗漏责任血管的风险,提高手术成功率。Objective To investigate the application value of 3D reconstruction technology using 3D Slicer software in the preoperative evaluation of patients with hemifacial spasm(HFS)undergoing microvascular decompression(MVD).Methods The clinical data of 200 patients with HFS who underwent MVD from June 2022 to December 2023 were retrospectively analyzed.All patients underwent 3D-FIESTA and 3D-TOF MRA preoperatively,and the 3D Slicer software was used for 3D reconstruction to guide MVD.The intraoperative finding was served as the gold standard.Results Except for one negative patient,responsible vessels were found intraoperatively in 199 patients,including anterior inferior cerebellar artery(AICA)in 111 patients,posterior inferior cerebellar artery in 52 patients,vertebral artery in 29 patients,and AICA combined with VA in 7 patients.The consistency between 3D-FIESTA and 3D-TOF MRA examination and intraoperative findings was generally(κvalue=0.326),the sensitivity,specificity,and accuracy were 83.90%,100.00%,and 91.00%,respectively.The consistency between 3D reconstruction technology and intraoperative findings was good(κvalue=0.651),the sensitivity,specificity,and accuracy were 99.00%,100.00%,and 100.00%,respectively.The prediction efficacy of 3D reconstruction technology on the responsible vessels was significantly better than that of 3D-FIESTA and 3D-TOF MRA examination(P<0.001).After follow-up for 6~24 months,with a median time of 12 months,complete symptom relief was achieved in 142 patients(71.00%),partial relief in 51(25.50%),and no change in 7(3.50%).Conclusion For patients with HFS,MVD guided by 3D reconstruction technology using 3D Slicer software based on the data of 3D-FIESTA and 3D-TOF MRA examination can reduce the risk of missing the responsible vessels,and improve the success rate of surgery.

关 键 词：面肌痉挛 显微血管减压术 3D-FIESTA 3D-TOF MRA 3D Slicer三维重建技术 疗效 

分 类 号：R651.3[医药卫生—外科学]