Aoyama Ryoma, Anazawa Ukei, Hotta Hiraku, Watanabe Itsuo, Takahashi Yuichiro, Matsumoto Shogo
Orthopaedics, Tokyo Dental College Ichikawa General Hospital, Ichikawa, JPN.
Cureus. 2022 Mar 12;14(3):e23096. doi: 10.7759/cureus.23096. eCollection 2022 Mar.
Several reports have compared spinal cord tumor removal techniques but none have clearly described the appropriate site and level of indication for laminectomy or laminoplasty. The approach method for tumor removal depends on the type and localization of the tumor and the surgeon's skill. Therefore, a system that can suggest various surgical techniques is useful for spinal cord tumor surgery. The mixed reality system introduced in this paper is an excellent system that can suggest various surgical procedures. Using this system for spinal cord tumor removal, we made the surgery less invasive; therefore, we introduced this system and demonstrated its usefulness. Stereoscopic data of the patients with spinal cord tumors were obtained from preoperative myelogram-CT data. Stereoscopic laminectomy models including tumors were created using Blender, a free three-dimensional (3D) image editing software. We observed these data as 3D object images using a head-mounted display (HMD). This HMD is commercially available and relatively inexpensive. The surgical procedure is determined by considering those 3D images, radiological diagnosis, and the skill of surgeons. Intraoperative confirmation of the laminectomy site could be performed using the HMD. The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases. Stereoscopic images using HMDs allow us a more intuitive understanding of the positional relationship between the tumor and spinal structure. These 3D object images can bring us more accurate preoperative planning and proper determination of surgical methods.
已有多篇报告对脊髓肿瘤切除技术进行了比较，但均未明确描述椎板切除术或椎板成形术的合适部位及适应证水平。肿瘤切除的入路方法取决于肿瘤的类型和位置以及外科医生的技术。因此，一个能够推荐各种手术技术的系统对脊髓肿瘤手术很有用。本文介绍的混合现实系统就是一个能够推荐各种手术程序的出色系统。使用该系统进行脊髓肿瘤切除，我们使手术的创伤性更小；因此，我们引入了该系统并展示了其效用。脊髓肿瘤患者的立体数据是从术前脊髓造影CT数据中获取的。使用免费的三维（3D）图像编辑软件Blender创建了包括肿瘤的立体椎板切除术模型。我们使用头戴式显示器（HMD）将这些数据作为3D对象图像进行观察。这种HMD在市场上有售且相对便宜。手术程序是通过考虑那些3D图像、放射学诊断和外科医生的技术来确定的。使用HMD可以在术中确认椎板切除部位。病理状况的3D可视化在所有5例病例中都实现了正确的术前手术规划并减少了手术创伤。使用HMD的立体图像使我们能够更直观地了解肿瘤与脊柱结构之间的位置关系。这些3D对象图像可以为我们带来更准确的术前规划和手术方法的恰当确定。
