术前肿瘤三维重建在幕上凸面脑肿瘤开颅术中的应用

Application of preoperative three-dimensional reconstruction of tumor in craniotomy for supratentorial convex brain tumor

目的探讨术前肿瘤三维重建用于幕上凸面脑肿瘤开颅术定位的准确性,为开颅手术提供一种精准、安全的辅助方法。方法前瞻性纳入2018年4月-2020年11月四川大学华西医院宜宾医院神经外科收治的幕上凸面脑肿瘤患者,随机分入重建组和对照组。重建组采用术前肿瘤三维重建进行开颅术定位,对照组采用传统二维断层影像进行开颅术定位。比较两组患者的基础情况、术中定位及肿瘤暴露情况满意率、骨窗最大直径、手术时间、脑引流静脉损伤情况和术后皮下积液或颅内感染发生情况。结果共纳入43例患者,重建组22例,对照组21例。两组患者的年龄、性别构成、中线移位发生率、肿瘤生长部位和肿瘤大小差异均无统计学意义(P>0.05)。两组患者的脑引流静脉损伤发生率和术后皮下积液或颅内感染发生率差异无统计学意义(P>0.05)。重建组的术中定位及肿瘤暴露情况满意率(95.5%vs.66.7%)高于对照组,骨窗最大直径[(6.26±1.32)vs.(7.31±1.13)cm]和手术时间[(194.00±22.76)vs.(214.57±26.53)min]低于对照组,差异均有统计学意义(P<0.05)。结论采用术前三维重建有助于更精确地定位肿瘤,提高肿瘤暴露满意率,缩小开颅骨窗直径,缩短手术时间,与传统的二维断层影像定位相比更具有优势。

Objective To investigate the accuracy of preoperative three-dimensional reconstruction of tumor in craniotomy for supratentorial convex brain tumors,and to provide an accurate and safe auxiliary method for craniotomy.Methods Patients with supratentorial convexity brain tumors who were admitted to the Department of Neurosurgery,West China Hospital,Yibin Hospital,Sichuan University between April 2018 and November 2020 were prospectively enrolled and randomly divided into reconstruction group and control group.In the reconstruction group,preoperative three-dimensional reconstruction of the tumor was used for craniotomy positioning,while in the control group,traditional two-dimensional tomographic imaging was used.The basic conditions,intraoperative localization and tumor exposure satisfaction rate,maximum diameter of bone window,operation time,cerebral draining vein injury,and postoperative subcutaneous effusion or intracranial infection were compared between the two groups.Results A total of 43 patients were included,22 in the reconstruction group and 21 in the control group.There was no significant differences in age,gender composition,incidence of midline shift,tumor growth site and tumor size between the two groups(P>0.05).There was no significant difference in the incidence of cerebral drainage vein injury and postoperative subcutaneous effusion or intracranial infection between the two groups(P>0.05).The satisfaction rate of intraoperative positioning and tumor exposure in the reconstruction group(95.5%vs.66.7%)was higher than that in the control group,the maximum diameter of the bone window[(6.26±1.32)vs.(7.31±1.13)cm]and the operation time[(194.00±22.76)vs.(214.57±26.53)min]were lower than the control group,and the differences were statistically significant(P<0.05).Conclusions Preoperative three-dimensional reconstruction helps to locate the tumor more accurately,improves the satisfaction rate of tumor exposure,reduces the diameter of the craniotomy window,and shortens the operation time.Compared with traditional two-dimensional tomographic positioning,it has more advantages.