三维可视化技术在中央区窦旁脑膜瘤手术中的应用

Application of 3D visualization technique during the surgery of parasagittal meningioma in central sulcus area

目的探讨三维可视化技术指导中央区窦旁脑膜瘤显微手术切除的效果。方法收集大连医科大学附属第一医院神经外科于2015年9月至2019年12月收治中央区窦旁脑膜瘤患者36例。其中男16例,女20例;年龄26~70岁。所有患者术前均在磁共振检查基础上建立三维可视化影像模型,均在三维可视化技术指导下行显微手术切除肿瘤。术后24小时复查头CT,以Simpson分级结合影像等检查评估肿瘤切除程度,以KPS评分评价患者术后功能分级。结果在术前三维可视化模型下,可清晰显示肿瘤与瘤周重要结构关系,术中所见与术前模型相符。术后24小时复查CT均未见需要手术处理的颅内血肿。36例患者中,29例获得全切,7例获得次全切。术后随访3~60个月,肿瘤复发4例,31例患者恢复良好KPS评分>80分可正常生活,3例KPS评分60分,轻度偏瘫生活可自理,1例KPS评分30分,重度偏瘫生活需辅助,1例术后28个月因肺栓塞死亡。结论三维可视化技术可清晰显示中央区窦旁脑膜瘤与瘤周重要结构关系,有利于术前制订手术计划及术中重要结构的保护,对中央区窦旁脑膜瘤的显微手术治疗有指导意义。

Objective To investigate the operational result of microsurgical resection of parasagittal meningiomas in central sulcus area under the guidance of 3 Dvisualization technique.Methods A collection of 36 patients with parasinus meningioma in the central region,who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Dalian Medical University from September 2015 to December 2019,was enrolled in the study.There were 16 men and 20 women with an age ranging 26-70 years.All patients were preoperatively established three-dimensional visualization imaging models based on magnetic resonance examination,and all tumors were removed by microsurgery under the guidance of three-dimensional visualization technology.The head CT was re-examined 24 hours after surgery,the degree of tumor resection was evaluated by Simpson classification combined with imaging and other examinations,and the postoperative functional classification was evaluated by KPS score.Results The preoperative 3 Dvisualization model clearly demonstrated structural relationship between the tumor and the surrounding anatomy;and the intraoperative findings were consistent with the preoperative model.Of the 36 patients,29 received total resection and 7 received subtotal resection.During the 3-60 months follow up after surgery,4 patients had tumor recurrence,31 patients recovered well with KPS score>80 points and returned to normal life,3 patients had mild disability with KPS score of 60 points and recovered gradually by themselves,1 patient had severe disability with KPS score of 30 points and needed life assistance,and 1 patient died of pulmonary embolism 28 months after surgery.Conclusions 3 Dvisualization technique can clearly show the relationship between parasagittal meningioma in the central sulcus area and the important structures around the tumor,which is beneficial for preoperative planning and intraoperative protection of important structures and provides guidance for microsurgical treatment of parasagittal meningiomas in the central sulcus area.