Chen H, Yan X, He F, Ding S C, Diao J F, Guo H, Cao S M, Yang C J, Yin F
Department of Neurosurgery, Aerospace Central Hospital, Beijing 100049, China.
Zhonghua Wai Ke Za Zhi. 2023 Jan 1;61(1):61-65. doi: 10.3760/cma.j.cn112139-20220610-00264.
To examine the application value of 3D Slicer software assisted domestic frameless stereotactic robot in biopsy of intracranial lesions. A retrospective analysis was performed on 80 patients who admitted consecutively and underwent intracerebral lesions biopsy with the domestic frameless stereotactic robot at Department of Neurosurgery, Aerospace Central Hospital from January 2019 to December 2021. There were 36 males and 44 females, with a mean age of (38.5±18.0) years (range: 6 to 71 years). Before surgery only enhanced T1-weighted three-dimensional magnetization prepared gradient echo sequences and diffusion tensor imaging scans were performed. Self-reconstruction of intracranial lesions, cerebral cortex and blood vessels was carried out using 3D Slicer software system after the DICOM format imaging data of 80 patients were collected. These imaging data were merged to the workstation of the domestic frameless stereotactic robot for preoperative surgical planning and the surgical puncture path was designed to avoid blood vessels in the brain functional area, cerebral cortex and sulcus. All frameless stereotactic biopsy were successfully performed. Postoperative pathological diagnosis included 50 cases of diffuse astrocytic and oligodendroglioma, 15 cases of lymphoma, 5 cases of metastatic tumors, 5 cases of inflammatory demyelinating disease, 2 cases of inflammatory granuloma, 1 case of hemangioma, 1 case of acute lymphoblastic leukemia intracranial invasion and 1 case of seminoma. The positive diagnosis rate was 100% (80/80). Postoperative imaging confirmed that the puncture path and target were accurately implemented according to the preoperative planning, and the target error was (1.32±0.44) mm (range: 0.55 to 1.99 mm). One case of puncture-related bleeding occurred at the target after surgery and improved after treatment. The three-dimensional multimodal images reconstructed by the 3D Slicer software before operation could help the surgeons make the preoperative planning and reduce the risk of stereotactic brain biopsy.
探讨3D Slicer软件辅助国产无框架立体定向机器人在颅内病变活检中的应用价值。回顾性分析2019年1月至2021年12月在航天中心医院神经外科连续收治并采用国产无框架立体定向机器人进行脑内病变活检的80例患者。其中男性36例，女性44例，平均年龄（38.5±18.0）岁（范围：6至71岁）。术前仅行增强T1加权三维磁化准备梯度回波序列及弥散张量成像扫描。收集80例患者的DICOM格式影像数据后，利用3D Slicer软件系统对颅内病变、脑皮质及血管进行自我重建。将这些影像数据导入国产无框架立体定向机器人工作站进行术前手术规划，设计手术穿刺路径以避开脑功能区、脑皮质及脑沟内的血管。所有无框架立体定向活检均顺利完成。术后病理诊断包括弥漫性星形细胞瘤和少突胶质细胞瘤50例、淋巴瘤15例、转移瘤5例、炎性脱髓鞘疾病5例、炎性肉芽肿2例、血管瘤1例、急性淋巴细胞白血病颅内浸润1例、精原细胞瘤1例。阳性诊断率为100%（80/80）。术后影像学检查证实穿刺路径及靶点均按照术前规划准确实施，靶点误差为（1.32±0.44）mm（范围：0.55至1.99 mm）。术后1例靶点处发生穿刺相关出血，经治疗后好转。术前通过3D Slicer软件重建的三维多模态影像有助于术者进行术前规划并降低立体定向脑活检风险。
