Yang J, Wu Y T, Dong K, Jiang H, Yang R, Wu Y, Xia H J, Sun X C, Zhong D
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):604-609. doi: 10.3760/cma.j.issn.0376-2491.2020.08.008.
To explore the methods and appliaction value for self-constructing brainstem fiber bundles by neurosurgeon through 3D-Slicer software in neurosurgical preoperative planning. The DCIOM format imaging data of 31 patients with neurosurgical brainstem lesions were collected who admitted to Neurosurgery Department at the First Affiliated Hospital of Chongqing Medical University from June 2018 to May 2019 and imported into the 3D-Slicer software system. The neurosurgery specialists independently constructed the fiber bundles to generate two-dimensional Fraction Anisotropy maps, Directionally Encoded Color maps and three-dimensional fiber bundle tracing maps. Building a preopertive virtual pathological anatomical imaging system and understanding the three-dimensional pathological anatomical relationship between lesions and brain stem fiber bundles to develop an accurate surgical approach and simulate surgicalprocedures before surgery. All cases were reconstructed by neurosurgeon, and the self-constructed 3D virtual images were used to develop the surgical plan. All the operations were successfully completed under the assistance of microsurgical techniques and neuroendoscopy while avoiding fiber bundles as much as possible, and the total or subtotal tumor was achieved without damage to the fiber bundle. After operation, the symptoms of new brainstem fiber bundle injury were mild. 31 patients were followed up 3 months after operation without obvious symptoms of brainstem fiber bundle injury, and 31 patients were followed up 6 months after operation without obvious symptoms of brainstem fiber bundle injury. Constructing brainstem fiber bundles by neurosurgeon can accurately and purposefully reconstruct the shape of brainstem fiber bundles, so that neurosurgeons can more accurately understand the three-dimensional pathological anatomical relationship between tumor and brain stem fiber bundles. In order to formulate the surgical plan in a more reasonable way, choose the optimal surgical approach, understand the location of the "relative safe area" , and be more confident to avoid damage to the brain stem fiber bundle while achieving subtotal or total resection of the tumor,also the nerve function of the patient is preserved as much as possible.
探讨神经外科医生通过3D-Slicer软件在神经外科术前规划中自主构建脑干纤维束的方法及应用价值。收集2018年6月至2019年5月重庆医科大学附属第一医院神经外科收治的31例脑干病变患者的DCIOM格式影像数据，并导入3D-Slicer软件系统。神经外科专家自主构建纤维束，生成二维各向异性分数图、定向编码彩色图和三维纤维束追踪图。构建术前虚拟病理解剖成像系统，了解病变与脑干纤维束的三维病理解剖关系，以制定精确的手术方案并在术前模拟手术过程。所有病例均由神经外科医生重建，利用自主构建的3D虚拟图像制定手术方案。所有手术均在显微外科技术和神经内镜辅助下成功完成，术中尽可能避开纤维束，实现肿瘤全切或次全切，且未损伤纤维束。术后脑干新的纤维束损伤症状较轻。31例患者术后3个月随访无明显脑干纤维束损伤症状，31例患者术后6个月随访无明显脑干纤维束损伤症状。神经外科医生构建脑干纤维束可准确、有目的地重建脑干纤维束形态，使神经外科医生更准确地了解肿瘤与脑干纤维束的三维病理解剖关系，从而更合理地制定手术方案，选择最佳手术入路，明确“相对安全区”位置，更有信心在实现肿瘤次全切或全切的同时避免损伤脑干纤维束，尽可能保留患者神经功能。
