第3脑室底造瘘术MRI简易锁孔定位技术研究

Study on MRI-guided localizing technique in neuroendoscopic third ventriculostomy

目的探求神经内镜第3脑室底造瘘术颅骨钻孔穿刺点的定位方法,确保手术操作时神经内镜直接到达第3脑室底乳头体前膜。方法利用MR具有多方位、多角度成像、组织分辨率高等特性,通过对头颅MR图像测量、计算,得出第3脑室底造瘘术穿刺点的坐标值。结果第3脑室底造瘘术穿刺点坐标距离鼻根(1272±99)mm或位于冠状缝前(171±56)mm、中线旁(203±47)mm,穿刺角度与大脑镰呈(123±19)°,自头皮至第3脑室底的深度(893±104)mm。讨论MRI直接引导的定位方法是一种定位准确,个体化设计的手术入路,操作简便、安全、无痛苦,易于普及开展且具有实际应用价值的简易定位方法。

Objective To investigate an accurate and applicable localizing method of puncture point for neuroendoscopic third ventriculostomy in neurosurgery so as to ensure that the neuroendoscope is led to the anterior membrane of mammillary body on the base of third ventricle directly. Methods Based on the MR characteristics including multiple directions and angles and high soft tissue resolution, the coordinate of puncture point was measured and calculated for neuroendoscopic third ventriculostomy in MRI. Results^The position of puncture point for neuroendoscopic third ventriculostomy was (127.2±9.9)mm to nasal root, or (17.1±5.6)mm in front of coronal suture and (20.3±4.7)mm to sagittal suture. The angle between the puncturing line and the cerebral falx was (12.3±1.9)°, and the depth from scalp to anterior membrane of mammillary body was (89.3±10.4)mm. Conclusion MRI-guided localization for neuroendoscopic third ventriculostomy is an accurate, simple, safe, painless, and applicable method.