Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.
Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.
Clin Neurol Neurosurg. 2020 Mar;190:105743. doi: 10.1016/j.clineuro.2020.105743. Epub 2020 Feb 21.
Recognizing the anatomical orientation surrounding the sellar floor is crucial in endoscopic endonasal transsphenoidal surgery (ETSS). Zero-echo-time (ZTE) sequences were recently suggested for a new bone identification technique on magnetic resonance imaging (MRI). This study aimed to evaluate the clinical usefulness of three-dimensional (3D)-ZTE-based MRI models in providing anatomical guidance for ETSS.
ZTE-based MRI and magnetic resonance angiography (MRA) data from 15 consecutive patients with pituitary tumor treated between September 2018 and May 2019 were used to create 3D-MRI models. From these, the architecture surrounding the sellar floor, particularly anatomical relationships between tumors and internal carotid arteries (ICAs), was visualized to preoperatively plan surgical procedures. In addition, 3D-ZTE-based MRI models were compared to actual surgical views during ETSS to evaluate model applicability.
These 3D-ZTE-based MRI models clearly demonstrated the morphology of the sellar floor and matched well with intraoperative views, including pituitary tumor, by successively eliminating sphenoidal structures. The models also permitted determination of the maximum marginal line of the opening of the sellar floor by presenting vital structures such as ICAs and tumors. With such 3D-MRI models, the surgeon could access the intracranial area through the sellar floor more safely, and resect the pituitary tumor maximally without complications.
Our 3D-MRI models based on ZTE sequences allowed distinct visualization of vital structures and pituitary tumor around the sellar floor. This new method using 3D-ZTE-based MRI models showed low invasiveness for patients and was useful in preoperative planning for ETSS, facilitating maximum tumor resection without complications.
在经鼻内镜蝶窦入路手术（ETSS）中，识别鞍底周围的解剖方位至关重要。零回波时间（ZTE）序列最近被提议用于磁共振成像（MRI）中的一种新的骨识别技术。本研究旨在评估基于三维（3D）-ZTE 的 MRI 模型在为 ETSS 提供解剖学指导方面的临床实用性。
使用 2018 年 9 月至 2019 年 5 月期间连续 15 例接受垂体瘤治疗的患者的 ZTE 基于 MRI 和磁共振血管造影（MRA）数据来创建 3D-MRI 模型。从这些模型中，可以可视化鞍底周围的结构，特别是肿瘤与颈内动脉（ICA）之间的解剖关系，以便术前规划手术程序。此外，在 ETSS 期间将基于 3D-ZTE 的 MRI 模型与实际手术视图进行比较，以评估模型的适用性。
这些基于 3D-ZTE 的 MRI 模型清楚地显示了鞍底的形态，与术中视图（包括垂体瘤）非常吻合，通过逐步消除蝶窦结构来实现。这些模型还可以通过显示 ICA 和肿瘤等重要结构来确定鞍底开口的最大边缘线。通过这些 3D-MRI 模型，外科医生可以通过鞍底更安全地进入颅内区域，并最大程度地切除垂体瘤而无并发症。
我们基于 ZTE 序列的 3D-MRI 模型允许清晰地显示鞍底周围的重要结构和垂体瘤。这种使用基于 3D-ZTE 的 MRI 模型的新方法对患者的侵入性较小，在 ETSS 的术前规划中非常有用，可以最大程度地切除肿瘤而无并发症。
