Liao Chang-Chun, Wu Kai-Hua, Chen Gang
Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University,China), Zhuhai, China.
Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University,China), Zhuhai, China.
World Neurosurg. 2023 May;173:e37-e47. doi: 10.1016/j.wneu.2023.01.088. Epub 2023 Jan 27.
To explore the application value of preoperative multimodal image fusion technique in microvascular decompression (MVD) surgery via the suboccipital retrosigmoid approach.
Comprehensive data of 13 patients with primary trigeminal neuralgia (TN) and 13 patients with hemifacial spasm (HFS) treated by MVD surgery via the suboccipital retrosigmoid approach at the Department of Neurosurgery in Zhuhai People's Hospital from January 2021 to December 2021 were retrospectively analyzed. Preoperatively, all patients underwent cranial thin-section computed tomography and magnetic resonance examinations. Three-dimensional (3D) digital images of the skull, brainstem, nerves, and blood vessels were constructed by the 3D-slicer software or RadiAnt DICOM Viewer, which were then applied to design the surgical approach and surgical plan. The multimodal image fusion results, clinical characteristics, intraoperative data, surgical outcomes, and complications of all patients were summarized.
The 3D digital images after fusion reconstruction can vividly show the anatomical relationship between the skull, brainstem, nerves, and blood vessels and was helpful to tailor the surgical strategy. All 26 patients underwent a smooth surgery. During the surgery, the key points were accurately located, the corners of the transverse sinus and sigmoid sinus were completely exposed, and no venous sinus injury occurred in all 26 patients. The key point was approximately located at the top point of the digastric groove, 12.3 ± 0.46 mm vertically above and 6.3 ± 0.6 mm laterally to the Frankfurt horizontal plane. The average cranial opening time was 30.4 (±3.6) min, and the mean operating time was 104.7 (±12.1) min. The diameter of the bone window was about 2.0 cm-3.0 cm, and the bone flap was restored. Among the 13 patients with primary TN, 12 (92.3%) exhibited complete relief of pain and 1 had significant relief. Complications of surgery included facial sensory numbness in 1 case, vertigo in 2 cases, and herpes at the corners of the mouth in 1 case. Of the 13 patients with HFS, 12 (92.3%) had complete relief of facial twitching symptoms and 1 had significant relief, and the complications included mild facial palsy in 2 (15.4%) cases and facial sensory numbness in another 2 (15.4%) cases. The mean follow-up time after surgery ranged from 6-16 months, and 1 of 26 patients experienced recurrence of HFS during the follow-up period.
Preoperative multimodal image fusion technology can provide adequate preoperative assessment for patients and assistance in designing surgical approaches, which is an important guideline for MVD surgery via the suboccipital retrosigmoid approach for primary TN and facial muscle spasm.
探讨术前多模态图像融合技术在枕下乙状窦后入路微血管减压术（MVD）中的应用价值。
回顾性分析2021年1月至2021年12月在珠海市人民医院神经外科接受枕下乙状窦后入路MVD手术治疗的13例原发性三叉神经痛（TN）患者和13例面肌痉挛（HFS）患者的综合资料。术前，所有患者均接受头颅薄层计算机断层扫描和磁共振检查。通过3D-slicer软件或RadiAnt DICOM Viewer构建颅骨、脑干、神经和血管的三维（3D）数字图像，然后应用于设计手术入路和手术方案。总结所有患者的多模态图像融合结果、临床特征、术中数据、手术效果及并发症。
融合重建后的3D数字图像能清晰显示颅骨、脑干、神经和血管之间的解剖关系，有助于制定手术策略。26例患者手术均顺利。术中关键点定位准确，横窦和乙状窦角完全暴露，26例患者均未发生静脉窦损伤。关键点大致位于二腹肌沟顶点，垂直于法兰克福水平面上方12.3±0.46mm，外侧6.3±0.6mm。平均开颅时间为30.4（±3.6）分钟，平均手术时间为104.7（±12.1）分钟。骨窗直径约2.0cm-3.0cm，骨瓣复位。13例原发性TN患者中，12例（92.3%）疼痛完全缓解，1例明显缓解。手术并发症包括面部感觉麻木1例、眩晕2例、口角疱疹1例。13例HFS患者中，12例（92.3%）面部抽搐症状完全缓解，1例明显缓解，并发症包括轻度面瘫2例（15.4%）、面部感觉麻木2例（15.4%）。术后平均随访时间为6-16个月，26例患者中有1例在随访期间出现HFS复发。
术前多模态图像融合技术可为患者提供充分的术前评估并辅助设计手术入路，是原发性TN和面肌痉挛枕下乙状窦后入路MVD手术的重要指导。
