【作者】 屈建强； 刘鹏弟； 闫先侠； 张熙； 周乐； 权俊杰；

【Author】 Jianqiang Qu;Pengdi Liu;Xianxia Yan;Xi Zhang;Le Zhou;Junjie Quan;the Second Affiliated Hospital of Xi’an Jiaotong University;

【机构】 西安交通大学第二附属医院神经外科；

【摘要】 目的利用开源3D Slicer软件为框架脑立体定向活检制定手术穿刺计划方案,探讨其术前指导意义及应用价值。方法于2020年11月至2021年12月,对因颅内占位需要行立体定向活检的12位患者,术前利用3DSlicer软件将CT、MRI等多种影像学资料进行多模态配准;重建颅内占位病灶、血管、脑室及脑组织,在三维视窗充分显示其空间位置关系,设定靶点并计算靶点坐标,通过调整穿刺的环角(Ring angle)及弧角(Arc angle)模拟最佳穿刺路径。结果 12例患者中,额叶占位3例,顶叶占位3例,丘脑占位3例,颞叶、胼胝体、基底节占位各1例。3DSlicer重建效果良好,病灶、血管、脑室及脑沟脑回显示清晰。12例患者均按术前模拟穿刺计划顺利完成手术,术后复查CT示活检取样部位与预设靶点位置吻合。患者术后无出血、感染及新发神经功能障碍。术后病理提示胶质瘤7例,淋巴瘤2例,生殖细胞瘤1例,室管膜瘤1例,出血坏死1例。结论在框架脑立体定向活检中,利用3DSlicer制定手术计划可以直观可视化地展现穿刺路径上的解剖结构,特别是在不具备机器人工作站和手术计划系统的单位,3D Slicer能帮助临床医师更加快速、深入地理解手术过程及操作要点,提高穿刺位置的准确性,降低手术风险。更多还原

【Abstract】 Objective To make a preoperative surgical plan for frame-based stereotactic brain biopsy by using the open-source 3D Slicer software,and elucidate its guiding significance.Methods From October 2020 to December 2021,for 12 patients who were scheduled for stereotactic brain biopsy due to intracranial space occupying lesions,3D Slicer was used for performing multi-modal registration of medical images such as CT and MRI.Lesions,vessels,ventricles,as well as brain tissues were reconstructed and fully displayed in a three-dimensional window.Then a target within the lesion was preset and its three-dimensional coordinates were calculated.By adjusting the Ring or Arc angle of the simulated puncture needle,an ideal puncture path could be made.Results Among the 12 space occupying lesions,3 were in frontal lobe,3 in parietal lobe,3 in thalamus,1 in temporal lobe,1 in corpus callosum and 1 in basal ganglia.The 3D reconstruction by 3D Slicer provided a good visualization for intracranial lesions,vessels,ventricles,sulci and gyri.The 12 stereotactic brain biopsies were successfully completed according to the preoperative simulated puncture plans.Postoperative CT showed that the biopsy sampling sites were consistent with the preset targets.Patients had no bleeding,infection or new neurological dysfunction.Postoperative pathological diagnosis revealed 7 gliomas,2 lymphomas,1 germ cell tumor,1 ependymoma and 1 hemorrhage and necrosis.Conclusion Make preoperative surgical plans in frame-based stereotactic brain biopsy with 3D Slicer can visually display the intracranial anatomy along the puncture path.Especially in centers without robot workstation and surgical planning system,3D Slicer could help neurosurgeons understand the surgical process and essentials more quickly and deeply,improve the accuracy of puncture and reduce the operation risk.更多还原