利用3D Slicer软件辅助定位行高血压脑出血微创穿刺治疗

Application of Location Technology Based on 3D Slicer Software in Minimally Invasive Puncture for Hypertensive Cerebral Hemorrhage

目的观察利用3D Slicer软件辅助定位进行高血压脑出血微创穿刺治疗的临床效果。方法我科2016年5月~2018年12月对26例高血压脑出血应用3D Slicer软件辅助定位行微创穿刺治疗。术前格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)6~15分,(8.6±1.7)分。CT提示壳核出血16例,脑叶出血4例,丘脑出血6例,出血量27.5~55 ml,(40.1±5.3)ml。术前行脑CT扫描,将原始DICOM格式数据,通过3D Slicer软件进行分析处理,计算血肿体积,完成头颅和深部血肿三维重建并融合,将图像用投影仪投射到患者头部并实现精准匹配,实现脑内血肿初步三维可视化,根据软件测算的穿刺深度和角度,在可视条件下精准定位穿刺血肿。术后向血肿腔内注射尿激酶液化血肿。术后第5日复查脑CT,以3D Slicer软件测量残留血肿的体积。结果所有患者均一次穿刺成功,精准穿刺率(导管通过血肿中心1 cm范围内且导管头端位于血肿范围内的比例)92.3%(24/26)。无术后再出血,无颅内感染。术后5日残留血肿量3~8 ml,(3.1±1.2)ml,血肿清除率83%~98%,(93.6±2.7)%。术后7天GCS 8~15分,(11.5±2.8)分。1例术后31天死亡。随访6个月,日常生活能力(activity of daily living,ADL)分级Ⅰ级5例,Ⅱ级9例,Ⅲ级8例,Ⅳ级2例,Ⅴ级1例。结论对于高血压脑出血,利用3D Slicer软件辅助有助于精准定位血肿,并设计优化穿刺路径。

Objective To observe the clinical effect of minimally invasive puncture of hypertensive cerebral hemorrhage with the 3 D Slicer software. Methods From May 2016 to December 2018, 26 patients with hypertensive cerebral hemorrhage in our department were treated with minimally invasive puncture assisted by the 3 D Slicer software. The Glasgow Coma Scale(GCS) score before surgery ranged 6-15 [mean,(8.6±1.7)]. The CT examination showed that there were 16 cases of putamen hemorrhage, 4 cases of lobar hemorrhage, and 6 cases of thalamic hemorrhage. The amount of hemorrhage ranged 27.5-55 ml [mean,(40.1±5.3) ml]. Before the operation, the patients were routinely examined by CT scanning, and the original DICOM data were analyzed and processed by the 3 D Slicer software to calculate the volume of hematoma. The 3 D reconstruction of skull and deep intracerebral hematoma were carried out to realize 3 D visualization after the fusion, then the image were projected onto the patient’s head with the projector and matching it accurately. The optimal puncture path was designed. According to the puncture depth and angle measured by the software, the hematoma was accurately located under visual conditions for minimally invasive puncture treatment. After the operation, urokinase was injected into the hematoma cavity to liquefy the hematoma. The brain CT was re-examined again on the 5th day after operation to measure the volume of residual hematoma with the 3 D Slicer software. Results All the patients were successfully punctured at one time, with a precise puncture rate(the proportion of catheters passing within 1 cm of the hematoma center and the catheter tip located within the hematoma) of 92.3%(24/26). There were no patients with postoperative re-bleeding or intracranial infection. The amount of residual hematoma was 3-8 ml on the 5th day after operation, with an average of(3.1±1.2) ml, and the hematoma clearance rate was 83%-98%, with an average of(93.6±2.7)%. The GCS score ranged 8-15 on the 7th day postoperatively, with an average of(11.5±2.8). One patient died 31 days later. Six months after the operation, the activity of daily living(ADL) grade showed grade Ⅰ in 5 cases, grade Ⅱ in 9 cases, grade Ⅲ in 8 cases, grade Ⅳ in 2 cases, and grade Ⅴ in 1 case. Conclusion For hypertensive cerebral hemorrhage, the 3 D Slicer software can help accurately locate the hematoma, and design and optimize the puncture path.