Oishi Makoto, Fukuda Masafumi, Ishida Go, Saito Akihiko, Hiraishi Tetsuya, Fujii Yukihiko
Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
Neurol Med Chir (Tokyo). 2011;51(3):201-7. doi: 10.2176/nmc.51.201.
The surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. Imaging data were collected from computed tomography, magnetic resonance imaging, and digital subtraction angiography. Skull data was processed to imitate actual bone resection and integrated with various structures extracted from appropriate imaging modalities by image-analyzing software. The simulated views were compared with the views obtained during surgery. All craniotomies and bone resections except opening of the acoustic canal in 2 patients were performed as simulated. The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.
颅底肿瘤（SBTs）手术具有挑战性，因为手术视野复杂且狭窄，受到颅骨和重要结构的限制。本研究评估了三维多融合容积成像（3-D MFVI）在显示SBTs预测手术视野方面的效用。对32例SBTs患者进行了基于3-D MFVI的术前模拟。收集计算机断层扫描、磁共振成像和数字减影血管造影的影像数据。对颅骨数据进行处理以模拟实际的骨切除，并通过图像分析软件与从适当影像模式中提取的各种结构进行整合。将模拟视野与手术中获得的视野进行比较。除2例患者的听神经管开放外，所有开颅和骨切除均按模拟进行。模拟视野能够通过预测的手术窗口观察预期的显微手术解剖结构，包括肿瘤、血管和颅神经。仅3例患者未能实现计划的肿瘤切除。3-D MFVI为SBTs手术提供了高质量的相关显微手术解剖图像。模拟的术中即视感增强了外科医生对计划手术操作的信心。
