CAJ | 학술논문

目的探讨三维数字影像融合技术在对颅内肿瘤进行术前风险评估和手术策略制定中的可行性和准确性. 方法 2012年1月至2012年6月,收治并进行术前三维重建的颅内肿瘤患者87例,术前行MRI扫描(包括常规MRI、MRA、MRV、DTI等序列),以上数据经iPlan 2.6软件重建数字图像并进行三维结构融合.术前、术中根据三维个体化解剖模型制定显微手术方案,对比术中、术前所见. 结果 87例患者的病变及周围重要的解剖、功能结构均得到三维重建并进行数字化融合；重建数字图像与术前原始影像和术中所见相符,肿瘤与周围解剖结构的空间关系与术前预期的一致；在基于此技术的导航辅助下,无入路相关并发症.大脑凸面肿瘤患者中,骨窗内见回流静脉紧靠肿瘤前方的有12例,回流静脉紧靠肿瘤后方的有19例,横跨肿瘤表面的有3例,均在术前数字图像中有很好的显示,开颅过程中回流静脉均有效的回避并加以保护；术中见动脉被肿瘤推移7例,被肿瘤包裹3例,与术前预测一致,当肿瘤包裹动脉时,术中辅以微血管多普勒超声监测准确定位并小心保护；脑实质深部(如丘脑-基底节区)肿瘤处理过程中,借助三维融合技术,综合考虑各个解剖结构的空间立体关系,很好的寻找到安全操作路径. 结论三维个体化数字解剖融合技术能够形象、可靠地显示病变空间位置,同时多角度呈现病变与周围重要解剖结构的立体关系,有助于宏观把握手术全局,降低误伤正常结构的机会.
목적 탐토삼유수자영상융합기술재대로내종류진행술전풍험평고화수술책략제정중적가행성화준학성. 방법 2012년1월지2012년6월,수치병진행술전삼유중건적로내종류환자87례,술전행MRI소묘(포괄상규MRI、MRA、MRV、DTI등서렬),이상수거경iPlan 2.6연건중건수자도상병진행삼유결구융합.술전、술중근거삼유개체화해부모형제정현미수술방안,대비술중、술전소견. 결과 87례환자적병변급주위중요적해부、공능결구균득도삼유중건병진행수자화융합；중건수자도상여술전원시영상화술중소견상부,종류여주위해부결구적공간관계여술전예기적일치；재기우차기술적도항보조하,무입로상관병발증.대뇌철면종류환자중,골창내견회류정맥긴고종류전방적유12례,회류정맥긴고종류후방적유19례,횡과종류표면적유3례,균재술전수자도상중유흔호적현시,개로과정중회류정맥균유효적회피병가이보호；술중견동맥피종류추이7례,피종류포과3례,여술전예측일치,당종류포과동맥시,술중보이미혈관다보륵초성감측준학정위병소심보호；뇌실질심부(여구뇌-기저절구)종류처리과정중,차조삼유융합기술,종합고필각개해부결구적공간입체관계,흔호적심조도안전조작로경. 결론 삼유개체화수자해부융합기술능구형상、가고지현시병변공간위치,동시다각도정현병변여주위중요해부결구적입체관계,유조우굉관파악수술전국,강저오상정상결구적궤회.
Objective To evaluate the reliability and accuracy of three-dimensional digital fusion anatomy in the preoperative evaluation and therapeutic strategy choice of intracranial tumors.Methods MRI scan,including regular MRI,MRA,MRV and DTI,were performed in 87 case.Then tumor themselves as well as tumor-associated structures were reconstructed and fused through iPlan 2.6 software.Based on the reconstructed images,therapeutic strategy were established,preoperative and intraoperative imags were compared.Results The digital reconstruction were successfully finished in all cases.Meanwhile,digital images,originally radiological images and actual images matched well.No approach-associated complication were met in our series.Among tumors in the convexity,the relationship of the reflux veins and the tumors were divided into three types:anterior(12 cases),posterior(19 cases) and overriding(3 cases).All of the relationships were seen in the preoperative fusion image,and the veins were all effectively protected during operation.The tumor-associated arteries could be pushed or wraped by the tumors,and the three-dimensional fusion image could provided their virtually aberrant pathway as well as their relationship with tumor.During microsurgical managment of tumors in the deep brain parenchyma,safe approach were found with the help of comprehensive understanding of the tumors and their adjacent structures.Conclusion Three-dimensional digital fusion anatomy can vividly and accurately display full rang of information about the tumor,and facilitate tumor treatment safely.