Chen S H, Yang J, Han H B, Cui D H, Sun J J, Ma C C, He Q Y, Lin G Z, Han Y F, Wu C, Ma K M, Zhang Y B
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Key Lab of Magnetic Resonance Imaging Device and Technique, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Jun 18;51(3):530-535. doi: 10.19723/j.issn.1671-167X.2019.03.023.
To investigate the values of diffusion tensor imaging (DTI) and virtual reality (VR) techniques in design surgery program of gliomas near eloquent regions.
In this study, 35 cases were retrospectively analyzed with gliomas involved language areas or rolandic regions operated in Department of Neurosurgery, Peking University Third Hospital from January 2015 to January 2019. Surgery programs were performed by Dextroscope virtual reality system. The pre-operative data, such as the magnetic resonance imaging (MRI), magnetic resonance arteriography (MRA) and DTI was transferred into the VR computer for restitution,Tumors, neural fiber tracts and blood vessels were reconstructed to simulate operation and design individual surgical plan. Neurological function was evaluated 1 week, 1 month and 3 months after operation.
Virtual reality three-dimensional images of the 35 cases were successfully achieved, including neural fiber tracts,blood vessels and the lesions. The displacement and destruction of fiber tracts, the anatomic relationship between tumor and important fiber bundle, artery and vein could be shown clearly. Surgical simulation and surgery program of VR of the 35 patients were successfully performed. The 3D images obtained from virtual reality near to the real surgery. Ten of the 35 cases were defined as rolandic regions tumors, 14 of the 35 cases were defined as language areas tumors and 11 of the 35 cases involved both language areas and rolandic regions. Complete resection of enhancing tumor (CRET) was achieved in 30 cases (85.7%), subtotal resection in 5 cases (14.3%), neurological function improved in 34 cases (97.1%) after operation,and 1 case had no improvement compared with that before(2.9%). Thirteen cases without neurological deficit pre-operation, showed transient neurological deficit ,which were recovered about 10 days post-operation, 12 of 22 cases with pre-operative neurologic deficit, improved one week postoperation, 9 of 22 cases with pre-operative neurologic deficit improved one month after operation, the rest 1 case was recurrent with glioblastoma with aggravated hemiplegia symptom after operation, who died of cerebral hernia 2 months later.
Dextroscope virtual reality system can clearly expose and quantify the 3D anatomic relationship of tumors, neural fiber tracts and blood vessels surrounding gliomas near eloquent regions, which is helpful to design the best individualized surgery program, to improve surgical effect.
探讨弥散张量成像（DTI）及虚拟现实（VR）技术在脑功能区附近胶质瘤手术方案设计中的应用价值。
回顾性分析2015年1月至2019年1月在北京大学第三医院神经外科手术的35例累及语言区或中央沟区的胶质瘤患者。采用Dextroscope虚拟现实系统制定手术方案。将术前磁共振成像（MRI）、磁共振血管造影（MRA）及DTI等数据传入VR计算机进行重建，对肿瘤、神经纤维束及血管进行重建以模拟手术并制定个体化手术方案。术后1周、1个月及3个月对神经功能进行评估。
成功获取35例患者的虚拟现实三维图像，包括神经纤维束、血管及病变。能清晰显示纤维束的移位及破坏情况，肿瘤与重要纤维束、动静脉的解剖关系。成功对35例患者进行了VR手术模拟及手术方案制定。VR获得的三维图像与实际手术情况接近。35例中，10例为中央沟区肿瘤，14例为语言区肿瘤，11例同时累及语言区和中央沟区。30例（85.7%）实现增强肿瘤全切除（CRET），5例（14.3%）次全切除，术后34例（97.1%）神经功能改善，1例与术前相比无改善（2.9%）。13例术前无神经功能缺损患者出现短暂性神经功能缺损，术后约10天恢复；22例术前有神经功能缺损患者中，12例术后1周改善，9例术后1个月改善，其余1例术后复发胶质母细胞瘤，偏瘫症状加重，2个月后死于脑疝。
Dextroscope虚拟现实系统能清晰显示并量化脑功能区附近胶质瘤周围肿瘤、神经纤维束及血管的三维解剖关系，有助于制定最佳个体化手术方案，提高手术效果。
