颅内3D静脉融合模型的建立及其在脑膜瘤切除术中的应用

Establishment of 3D venous-fusion models and their application in meningioma operations

目的探讨3D静脉融合模型在脑膜瘤切除术中的应用价值。方法选择福州总医院神经外科自2015年3月至2015年7月收治的颅内脑膜瘤患者19例，分别将其术前、术后对比增强磁共振静脉成像（CE—MRV）原始资料导入神经导航仪手术计划系统，进行3D静脉融合模型的构建．对肿瘤和静脉进行模型重建、分割、融合，依此对颅内静脉循环做围术期评估，术中应用实时导航实施肿瘤和静脉的定位。结果3D静脉融合模型显示效果良好，手术中所见肿瘤与周边静脉窦、静脉血管的关系与术前评估完全吻合。19例患者开颅手术中均应用神经导航定位静脉位置并予以保护，术后均未发生明显的静脉源性并发症。术前、术后3D静脉融合模型对比提示静脉保护效果符合预期。结论应用神经导航仪建立的3D静脉融合模型，能准确评估颅内静脉与肿瘤的相对关系。此模型能使术者对肿瘤及周围静脉的影像资料从三维角度有更深入的了解．有利于制订较为合理的静脉保护策略。

Objective To explore the role of 3D venous-fusion models in the resection of meningiomas. Methods The study included 19 patients with meningiomas, admitted to our hospital from March 2015 to July 2015. The preoperative and postoperative contrast enhancement MR venography （CE-MRV） data were imported into the neuronavigator system. The establishment of 3D venous-fusion models was performed; reconstruction, cropping, fusion of the intracranial venae and rumors were performed. 3D venous-fusion models were used to evaluate the intracranial venous circulation, and the positions of venae and tumors were navigated in real-time. Results 3D venous-fusion models showed good results. The position relationship of tumors and their surrounding venous was perfectly assessed in operation. Nineteen patients underwent craniotomy using neuronavigator to locate venous position, and no postoperative venous complications occurred. The contrast of preoperative and postoperative 3D venous-fusion models prompted that the venous protection was in line with expectations. Conclusions The 3D venous-fusion models established by neuronavigator can accurately evaluate the relationship between cerebral venous and the tumors. These models help the operator making a better understanding of tumors and their peripheral venous imaging data from 3D perspective. It is benefit for the operator to make a more reasonable venous protect strategy.