3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤中的应用

3D technology for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction

目的探讨3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤及颅底功能重建手术中的作用。方法对21例鼻颅底恶性肿瘤患者术前行鼻窦冠状位CT或MRI扫描,并行3D影像重建及模型打印,根据3D成像及模型了解鼻颅底恶性肿瘤侵及范围、颅底及眶壁骨质的缺损大小形状,制定鼻内镜手术术式、肿瘤精准切除范围及颅底功能精准重建方法。结果患者肿瘤均一次手术全切除,其中6例行颅底功能精准重建术,无脑脊液鼻漏及颅内感染并发症。术后病理示鳞癌9例,嗅母细胞瘤5例,腺样囊腺癌3例,横纹肌肉瘤4例。术后行正规放疗,横纹肌肉瘤患者加化疗。经平均随访36个月,未发现肿瘤复发及与本肿瘤相关的死亡。结论 3D成像及打印模型能清楚显示鼻颅底恶性肿瘤范围、颅底及眶壁骨质缺损的大小及形状,并有助于术者选择最佳内镜手术入路及手术方案,有重要临床指导作用。

Objective To explore the value of 3D technology for accurate treatment of transnasai endoscopic nasal skull base neoplasm resection and the functional reconstruction of the nasal skull base surgery. Methods A total of 21 cases of nasal skull base neoplasm were carried out sinus coronal CT/MRI scan parallel 3D reconstruction and 3D printing. The invasion scope of the nasal skull base neoplasm and the size/shape of the bony defect of the skull base and orbital wall were read according to 3D reconstruction and 3D model, then the surgery path and the accurate resection range and the accurate reconstruction method were determined. Results All patients＇ neoplasm had been removed in the first operation. 6 cases had been performed accurate functional reconstruction of the skull base surgery without cerebrospinal fluid （CSF） leak and intracranial infection happened. Post-operative pathology indicated that there were 9 cases of squamous cell carcinoma, 5 esthesioneuroblastoma, 3 adenoid cystic carcinoma and 4 rhabdomyosarcoma. Patients accepted radiotherapy after surgery. Within a follow-up of 36 months on average, no neoplasm relapsed and no death that is connect whit the neoplasm appeared. Conclusion 3D reconstruction and 3D model could show the invasion scope of the nasal skull base neoplasm and the size/shape of the bony defect of the skull base and the orbital wall clearly. Also 3D reconstruction and 3D model could help surgeons to make the best operative schemes. 3D imaging and 3D printing technology has important guiding significance for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction of the nasal skull base surgery.