3D-Slicer联合Sina软件在高血压脑出血神经内镜手术的应用

Application of 3D-Slicer and Sina software in minimally invasive surgery under neuroendoscope for hypertensive intracerebral hemorrhage

目的探讨3D-Slicer联合Sina软件在高血压脑出血神经内镜手术术前定位的应用价值。方法回顾性分析18例应用3D-Slicer联合Sina软件辅助神经内镜手术治疗的高血压脑出血病例资料,运用3D-Slicer软件对颅内血肿和头颅轮廓进行虚拟重建,运用手机Sina软件准确勾画出颅内血肿体表投影,设计合适穿刺路径,进而在神经内镜辅助下行颅内血肿清除术,并评估术后疗效。结果 18例病人均实现血肿体表定位,工作鞘均能穿刺至预设的血肿位置,经神经内镜观察证实,并完成颅内血肿清除。术后第1天血肿清除率>90%13例,>80%～90%3例,>70%～80%2例,平均血肿清除率为90.3%。无术后再出血、颅内感染,发生肺部感染2例。根据术后3个月随访GOS评价预后:恢复良好5例,轻度残疾11例,重度残疾2例。结论3D-Slicer联合Sina软件可为高血压脑出血神经内镜手术治疗提供快速、简便、准确、可靠的术前定位。

Objective To explore the application value of 3D-Slicer and Sina software in the preoperative localization of hypertensive intracerebral hemorrhage（HICH） in minimally invasive surgery with neuroendoscope. Methods Clinical data of 18 HICH patients who underwent neuroendoscope minimally invasive surgery assisted with 3D-Slicer and Sina software. The intracranial hematoma and the contour of the skull were virtually reconstructed by using 3D-Slicer software, the surface projection of intracranial hematoma was drawn accurately by using Sina software of mobile phone, the appropriate puncture path was designed, and then intracranial hematoma was evacuated under neuroendoscope and surgical outcome was evaluated. Results The hematoma localization in body surface was achieved in 18 patients. The sheath can be punctured to the preset hematoma location. It was confirmed by endoscopy and complete evacuation of intracranial hematoma was finished. There were 13 patients whose hematoma evacuation rates were more than 90% on the first day after surgery, 3 whose hematoma evacuation were from 80% to 90% and 2 whose hematoma evacuation rate from 70% to80%. The average hematoma evacuation was 90.3%. No rebleeding after surgery and intracranial infection occurred and the pulmonary infection occurred in 2. After 3-month follow-up period, the GOS score results were as follows： good recovery was achieved in 5, mild disability in 11 and severe disability in 2. Conclusion 3D-Slicer and Sina software can provide rapid, simple, accurate and reliable preoperative localization for neuroendoscope minimally invasive surgery for HICH.