Trolard静脉的显微解剖与多模态影像三维重建的观察

The observation of microanatomy of Trolard vein and its three-dimensional reconstruction of multimodal images

目的应用多模态影像三维重建联合显微解剖观察Trolard静脉及其相吻合静脉情况及临床意义。方法回顾性分析2017年9月至2020年3月菏泽市立医院神经外科行头颅三维对比增强磁共振静脉血管成像(3D-CEMRV)检查的50例(100侧)患者的影像学资料,通过头颅MRI T1加权成像的三维磁化强度预备梯度回波序列、三维时间飞跃法血管成像序列和3D-CEMRV序列在3D Slicer软件中建立多模态影像三维重建模型,观察Trolard静脉及其相吻合的大脑中浅静脉、大脑浅静脉的形态并测量Trolard静脉的管径。将20具(40侧)尸头标本的动、静脉分别使用红、蓝色乳胶进行灌注,显微镜下观察Trolard静脉及其吻合静脉构成并测量Trolard静脉的管径。结果50例(100侧)患者的三维重建模型中,Trolard静脉共117支,其中左侧61支,右侧56支,管径分别为(1.23±0.78)mm、(1.19±0.79)mm,两侧静脉管径的差异无统计学意义(t=0.28,P=0.784);Trolard静脉单干型23侧(23%)、双干型26侧(26%)、三干型14侧(14%)、缺如型37侧(37%);大脑中浅静脉单干型32侧(32%)、多干型62侧(62%)、无明显形成型6侧(6%);大脑浅静脉及其吻合静脉的最小管径为1 mm。20具(40侧)尸头标本显微解剖观察中,Trolard静脉共41支,其中左侧22支,右侧19支,管径分别为(1.06±0.61)mm、(1.13±0.59)mm,两侧静脉管径的差异无统计学意义(t=0.37,P=0.712);Trolard静脉单干型15侧(37.5%)、双干型10侧(25.0%)、三干型2侧(5.0%)、缺如型13侧(32.5%);大脑中浅静脉单干型14侧(35.0%),多干型23侧(57.5%),无明显形成型3侧(7.5%);显微镜下可观察到大脑浅静脉及其吻合静脉的最小管径为0.5 mm。显微解剖观察左、右侧Trolard静脉的管径与三维重建模型相比,差异均无统计学意义(均P>0.05)。结论Trolard静脉的解剖结构变异较大,三维影像重建模型可清晰地显示大部分Trolard静脉及其相吻合静脉,可弥补显微解剖的不足。

Objective To investigate the observation and clinical significance of multimodal three-dimensional reconstruction combined with microsurgical anatomy on Trolard veins and their anastomotic veins.Methods The imaging data of 50 patients(100 sides)who underwent three-dimensional contrast enhanced magnetic resonance venography(3D-CEMRV)in the Department of Neurosurgery,Heze Munici-pal Hospital from September 2017 to March 2020 were retrospectively analyzed.Head MRI multimodal image 3D reconstruction models were established in 3D Slicer for T1-weighted imaging of three-dimensional magnetization-prepared rapid gradient-echo sequence,three-dimensional time-of-flight magnetic resonance angiography and 3D-CEMRV sequence.The morphology of Trolard vein and its connecting superficial middle cerebral vein and superficial cerebral vein were observed,and the outer diameter of Trolard vein was measured.The arteries and veins of 20(40 sides)adult cadaver specimens were injected with red and blue latex,respectively,and the composition of Trolard veins and its connecting cerebral veins were observed under the microscope.At the same time,the outer diameters of Trolard veins were measured.Results Based on the three-dimensional image fusion model of the 50 patients(100 sides),117 Trolard veins were seen in all including 61 Trolard veins on the left side with a mean outer diameter of 1.23±0.78 mm and 56 Trolard veins on the right side with a mean outer diameter of 1.19±0.79 mm.There was no statistical significance in the mean outer diameter of the two sides(t=0.28,P=0.784).There were 23 sides(23%)with Trolard vein of single trunk type,26 sides(26%)with Trolard vein of double trunk type,14 sides(14%)with Trolard vein of triple trunk type,and 37 sides(37%)without Trolard vein.There were 32 sides(32%)of superficial middle cerebral vein(SMCV)of single trunk type,62 sides(62%)with SMCV of multiple trunks,and 6 sides(6%)with SMCV of no obvious formation.The minimum diameter of the superficial cerebral vein and its anastomotic veins was 1 mm.In the microanatomical observation of 20 cadaver head specimens(40 sides),there were 41 Trolard veins in total,22 on the left with a diameter of 1.06±0.61 mm,and 19 on the right with a diameter of 1.13±0.59 mm.There was no statistically significant difference in the diameter of lateral veins(t=0.37,P=0.712).There were 15 sides(37.5%)with Trolard veins of single trunk type,10 sides(25.0%)with double trunk type,2 sides(5.0%)with triple trunk type,and absent type on 13 sides(32.5%).The SMCV of single trunk type was found on 14 sides(35.0%),multiple trunk type on 23 sides(57.5%),and no obvious formation on 3 sides(7.5%).It was revealed under the microscope that the minimum diameter of the superficial cerebral vein and its anastomotic veins was 0.5 mm.There was no statistically significant difference in the diameter of the left or right Trolard vein between microscopic observation and three-dimensional reconstructed model(both P>0.05).Conclusion The anatomical structure of the Trolard vein varies greatly.The three-dimensional image reconstruction model can clearly display the Trolard vein in most cases and its anastomotic veins,which can make up for the shortcomings of microanatomy.