神经导航结合DTI在视辐射区病灶切除术中视觉保护的研究

Study on visual protection of neuronavigation combined with DTI in lesion resection in optic radiation area

目的探讨神经导航结合弥散张量成像(DTI)在视辐射区病灶手术中的应用价值,以及视辐射形态损伤的影响因素。方法回顾分析南京医科大学附属脑科医院神经外科2018年1月—2019年5月,收治的28例视辐射区受累患者的临床资料。其中胶质瘤14例、脑膜瘤4例、海绵状血管瘤4例、转移瘤3例、淋巴瘤3例。患者均行视力视野检查,填写视功能量表及生存质量量表。用DTI观察患者患侧视辐射,根据视辐射的形态进行评分(1~4分),分析影响患者视辐射的因素。根据病灶与视辐射的三维关系设计手术入路,术中在纤维束融合导航引导下按预定路径切除病灶。出院时及出院后2个月再次检测视力视野,随访调查视功能及生存质量。结果本组患者中,病灶全切除者21例(75.0%),次全切除4例(14.3%),大部切除2例(7.1%),部分切除1例(3.6%)(术中快速病理检查示淋巴瘤)。患者术前视辐射形态评分为(2.5±1.0)分。视辐射形态正常组与破坏组患者之间病灶大小、是否水肿、是否累及侧脑室颞角上的差异有统计学意义(P=0.006~0.001)。病灶>3 cm(OR=3.357,95%CI:0.260~2.161,P=0.013)、水肿(OR=0.070,95%CI:-5.179^-0.146,P=0.038)、累及侧脑室颞角(OR=0.081,95%CI:-4.695^-0.341,P=0.023)是导致视辐射形态学损伤的影响因素。本组患者入院、出院及出院后2个月的视力视野比较,差异有统计学意义(均P<0.05);入院及出院后2个月的视功能和生存质量评分比较,差异有统计学意义(均P<0.05)。结论病灶>3 cm、水肿、累及侧脑室颞角是导致视辐射形态受损的影响因素。神经导航结合DTI应用于视辐射区肿瘤手术,可辅助制定合理的手术入路,术中有效及最大化地切除病灶,同时避免视辐射损伤,有助于保护患者的视觉功能。

Objective To explore the application value of neuronavigation combined with diffusion tensor imaging(DTI)in the treatment of lesions located in optic radiation area,and the influencing factors of the optic radiation from damage.Methods The clinical data of 28 patients with optic radiation area involvement in the Department of Neurosurgery,Brain Hospital Affiliated to Nanjing Medical University from January 2018 to May 2019 were analyzed retrospectively.Of 28 patients,14 were glioma,4 meningioma,4 cavernous hemangioma,3 metastases and 3 lymphoma.All patients admitted to the hospital underwent visual acuity and visual field examination,filled out visual function scale and quality of life scale,and used DTI technique to track the side optic radiation,scored according to the pattern of optic radiation(1 to 4 points).The adverse factors affecting the patient's optic radiation were analyzed.A surgical approach was designed according to the three-dimensional relationship between the lesion and the optic radiation.The lesion was removed under the guidance of the navigation combined with the fiber bundle.Visual acuity and visual field of all patients were re-examined when they were discharged and 2 months after discharge,and the visual function and quality of life were followed up.Results Of 28 patients,21 underwent total resection(75.0%),4 subtotal resection(14.3%),2 major resection(7.1%),and 1 partial resection(3.6%)(intraoperative rapid pathology suggested lymphoma).The average preoperative optic radiation pattern score of the patients was(2.5±1.0)points.There was a statistically significant difference in lesion size,edema,and invasion of lateral ventricle temporal horn between normal and ruptured groups(P=0.006-0.001).Lesions>3 cm(OR=3.357,P=0.013,95%CI:0.260-2.161),edema(OR=0.070,P=0.038,95%CI:-5.179--0.146),invasion of lateral ventricle temporal horn(OR=0.081,P=0.023,95%CI:-4.695--0.341)were unfavorable factors affecting the damage of optic radiation.The visual acuity and visual field results of this group of patients admitted to hospital,discharged,and discharged from hospital 2 months were compared.The difference was statistically significant(P<0.05).The visual function and quality of life scores were compared between admission and 2 months after discharge.The difference was statistically significant(P<0.05).Conclusions Lesions>3 cm,edema,invasion of lateral ventricle temporal horn are unfavorable factors affecting the damage of optic radiation.The application of neuronavigation combined with DTI in the operation of lesions in the optic radiation area can assist in formulating a reasonable surgical approach,remove the lesions effectively and maximally during the operation,and avoid optic radiation damage,which helps protect the visual function of the patients.