术前多模态影像三维重建在神经内镜显微血管减压术中的应用价值

The application value of preoperative multimodal image three-dimensional reconstruction in neuroendoscopic microvascular decompression

目的探讨术前多模态影像三维重建技术在神经内镜显微血管减压术(MVD)中的应用价值.方法回顾性分析2019年4月至2021年12月潍坊市人民医院神经外科收治的行神经内镜MVD治疗的48例患者的临床资料,其中,三叉神经痛(TN)18例,面肌痉挛(HFS)30例.所有患者术前均行头颅MRI三维循环相位稳态采集快速成像(3D-FIESTA)和三维时间飞跃法磁共振血管成像(3D-TOF-MRA)检查,并对神经、血管等结构进行影像学三维重建;采用Kappa一致性检验评价术前多模态影像三维重建与神经内镜MVD术中所见的责任血管、责任血管的走行及其与神经或神经根进/出脑干区(REZ)的接触关系、责任血管对神经压迫程度的一致性;根据TN疼痛分级或HFS强度分级评估患者术后1、3、6个月症状的改善程度.结果48例患者术前多模态影像三维重建显示,除3例无法确认责任血管外,其余45例均有明确的责任血管;所有患者的神经内镜MVD手术均顺利完成,其中46例均有明确的责任血管;多模态影像三维重建判断责任血管的准确率为91.3%(42/46);判断责任血管走行及其与神经或REZ接触关系的准确率为93.8%(45/48);判断责任血管对神经压迫程度的准确率为100%(21/21).Kappa一致性检验结果显示,多模态影像三维重建与神经内镜MVD术中责任血管、责任血管走行及其与神经或REZ接触关系、责任血管对神经压迫程度均具有中等一致性(Kappa值分别为0.63、0.74、0.68,均P<0.001).48例患者均无颅内感染、症状复发等情况发生,中位随访时间为4个月(1~6个月);至末次随访,18例TN患者中,17例疼痛消失,1例部分缓解;30例HFS患者中,29例痊愈,1例明显缓解.结论术前多模态影像三维重建技术可较为准确地评估责任血管、责任血管走行及其与神经或REZ的接触关系、责任血管对神经的压迫程度,提高神经内镜MVD的准确率及成功率,有效改善脑神经激惹症状.

Objective To evaluate the application value of preoperative three-dimensional(3D)multimodal image reconstruction in neuroendoscopic microvascular decompression(MVD).Methods The clinical data of 48 patients who received neuroendoscopic MVD treatment in Neurosurgery Department of W eifang People's Hospital from April 2019 to December 2021 were retrospectively analyzed,ineluding 18 cases of trigeminal neuralgia(TN)and 30 cases of hemifacial spasm(HFS).All patients underwent cranial MRI three-dimensional fast imaging employing steady-state acquisition(3D-FIESTA)and three-dimens ional time-of-flight magnetic resonance angiography(3D-TOF-MRA)examinations before operation,imaging fusion was performed and reconstruction of nerves,blood vessels and other structures was made.Kappa consistency test was used to evaluate the consistency of the offending vessels,the course of the offending vessels and the contact relationship between the offending vessels and the nerve or the nerve exit/entry brain stem area(REZ),and the degree of pressure of the offending vessels on the nerves seen in the preoperative three-dimensional reconstruction of multi-modal images and neuroendoscopic MVD.According to the TN pain classification or the HFS intensity clasification,the improvement of the symptoms of the patients at 1,3,and 6 months after operation was evaluated.Results Preoperative 3D multimodal image reconstruction of 48 patients showed that there were 3 patients whose offending vessels could not be identified and the other 45 patients had clear offending vessels.Neuroendoscopie MVD was successfully completed for all patients,46 of whom had clear offending vessels.The accuracy of 3D reconstruction of multi-modal images in identifying offending vessels was 91.3%(42/46),the accuracy of judging vascular shape and neurovascular relationship was 93.7%(45/48),and the accuracy of judging the degree of vascular compression on nerve was 100%(21/21).The results of Kappa consistency test showed that the offending vessels,the course and their contact relationship with nerve or REZ,and the degree of vascular compression on nerve were moderately consistent between the 3D reconstruction of multi-modal images and neuroendoscopic MVD(Kappa coefficient:0.63,0.74,0.68,all P<0.001).None of the 48 patients had intracranial infection or recurrence,the median follow-up time was4 months(1-6 months).The latest follow-up showed that in the case of 18 TN patients,17 recovered and 1 had partial remission;in 30 patients with HFS,29 recovered,1 significantly remission.Conclusion Preoperative application of multimodal fusion 3D reconstruction technology can accurately evaluate the offending vessels,the course of offending vessels,their contact relationship with nerve or the REZ and the degree of vascular compression on nerve,which is helpful to improve the accuracy and success rate of neuroendoscopic MVD and effctively reduce the cranial nerve irritation.