脑表面三维重建技术在局灶性皮质发育不良切除术中的应用

Three-dimensional brain surface visualization for resection of focal cortical dysplasia

目的研究脑表面三维重建技术在局灶性皮质发育不良(focal cortical dysplasia,FCD)切除术中的应用及其可靠性。方法研究纳入2015年至2016年期间病理确诊为FCD的患者。术前行包含3D T1序列的MRI检查,经过详尽的术前评估后确定致痫灶的位置与范围。术前利用软件将3D T1影像中的头皮,颅骨及硬脑膜去除后进行脑表面三维重建,然后根据二维影像的切除范围定位出三维影像中应切除的脑沟与脑回。术中开颅后仔细辨认实际脑表面的脑沟和脑回的形态与走形,与重建图像对比并建立对应关系后切除相应的脑组织。术后根据复查的头颅CT或MRI确定切除范围是否充分,并分析可能影响全切率的相关因素。结果总共有58例患者纳入本研究,总体全切率和术后无发作率分别为89.66%和84.48%。再次手术,无颅内电极指引和病灶为MRI阴性并不影响全切率;病灶位于深部结构和功能区导致全切率降低,但尚未到达统计学意义。结论脑表面三维重建技术辅助指导FCD切除安全有效,易于操作。当癫痫手术为再次手术,致痫灶位于深部结构和功能区时,建议结合深部电极指引和电生理监测等其它辅助手段。

Objective To evaluate the assistant value of 3-dimensional（3-D）brain surface visualization for intraoperative guidance in focal cortical dysplasia（FCD）resection.Methods Consecutive patients operated for histopathological confirmed FCD from 2015 to 2016 were included in this study.Pre-surgical 3 D T1 MRI examination was performed,the location and extent of epileptogenic zone were proposed after elaborate evaluation conferences.The scalp,skull and dura in MRI image were removed and the brain surface was visualized by using dedicated software packages.The suspected gyri and sulci were localized in the 3-D brain surface image according to the extent delineated in the 2-D images.The shape and course of the gyri and sulci in the rendered image were compared with those in the operative live view,and the suspected tissue was localized and removed when the rendered image matched the live view.Post-surgical CT or MRI scan was used to confirm if the extent of resection satisfied the proposal plan,and potential factors associated with complete resection were analyzed.Results Fifty-eight patients were included in the present study,the overall complete resection rate and seizure-free rate was 89.66%and 84.48%,respectively.Reoperation,absence of intracranial electrode guidance and absence of MRI-visible lesion did not affect the complete resection rate;Lesion located in the deep structures and eloquent areas reduced the complete resection rate,while did not reach statistical significance.Conclusion The brain surface visualization technique was safe,effective and easy accessible in guidance of FCD resection.In case of reoperation and presence of deeply or eloquently located lesion,additional techniques including intracranial electrode guidance and electrophysiological monitoring were recommended.