3DSlicer多模态融合三维可视化技术辅助切除边缘系统胶质瘤的临床效果和预后分析

doi:10.19854/j.cnki.1008-2425.2024.02.0003

摘要/Abstract

摘要： 目的探讨3DSlicer多模态融合三维可视化技术辅助切除边缘系统胶质瘤手术治疗的临床价值。方法回顾分析我院收治的67例边缘系统胶质瘤临床资料,按照手术方法分为3DSlicer重建组(实验组)32例和传统手术组(对照组)35例。分析实验组和对照组在认知功能(MMSE)评分及术后一月卡氏评分(Karnofsky performance status,KPS)、肿瘤切除程度、并发症等临床疗效的差异。结果术后实验组认知功能MMSE评分(28.50±2.20),高于对照组(25.40±4.972), P=0.002,差异显著;术后一月实验组KPS评分(94.53±7.112),高于对照组(84.86±10.396),P＜0.001,差异显著;实验组肿瘤全切除率高于对照组(Z=-3.271,P＜0.001);对照组并发症发生率高于实验组。结论 3DSlicer多模态融合三维可视化技术可以指导手术入路、最大化安全切除边缘系统胶质瘤,降低术后认知和神经功能障碍,减少相关并发症,增加患者生活质量。

关键词: 三维可视化, 胶质瘤, 边缘系统, 认知功能, 并发症

Abstract: Objective To investigate the clinical value of 3DSlicer multi-modal fusion 3D visualization technology in assisting the surgical treatment of limbic system glioma. Methods The clinical data of 67 cases of limbic glioma treated in our hospital were retrospectively analyzed and divided into 32 cases of 3DSlicer reconstruction group(experimental group) and 35 cases of traditional operation group(control group) according to surgical methods.The differences of cognitive function(MMSE) score, Karnofsky performance status(KPS), tumor resection degree, complications and other clinical effects between the experimental group and the control group were analyzed. Results The MMSE score of cognitive function in the experimental group(28.50±2.20) was higher than that in the control group(25.40±4.972), P=0.002, the difference was significant.One month after operation, the KPS score of the experimental group(94.53±7.112) was higher than that of the control group(84.86±10.396), with significant difference(P＜0.001).The total resection rate of the experimental group was higher than that of the control group(Z=-3.271, P＜0.001).The complication rate of the control group was higher than that of the experimental group. Conclusion 3DSlicer multi-modal fusion 3D visualization technology can guide the surgical approach, maximize the safe resection of limbo system glioma, reduce postoperative cognitive and neurological dysfunction, reduce related complications, and increase the quality of life of patients.

Key words: Three-dimensional visualization, Glioma, Limbic system, Cognitive function, Complications

中图分类号:

P739.41

刘家记, 卢旭, 李冬雪. 3DSlicer多模态融合三维可视化技术辅助切除边缘系统胶质瘤的临床效果和预后分析[J]. 立体定向和功能性神经外科杂志, 2024, 37(2): 77-82.

Liu Jiaji, Lu Xu, Li Dongxue. 3D visualization technique assisted resection of limbic glioma by 3DSlicer[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 77-82.

参考文献

[1] Grodd W,Kumar VJ,Schüz A,et al.The anterior and medial thalamic nuclei and the human limbic system:tracing the structural connectivity using diffusion-weighted imaging[J].Sci Rep,2020,10(1):10957.
[2] Gong F,Jin L,Song Q,et al.Surgical techniques and function outcome for cingulate gyrus glioma,how we do it[J].Front Oncol,2022,12:986387.
[3] 韩彦钧,乔广宇.边缘系统低级别胶质瘤的诊断与显微外科治疗[J].肿瘤研究与临床,2011,23(3):205~207.
[4] 国家卫生健康委员会医政医管局,中国抗癌协会脑胶质瘤专业委员会,中国医师协会脑胶质瘤专业委员会.脑胶质瘤诊疗指南(2022版)[J].中华神经外科杂志,2022,38(8):757~777.
[5] Yaşargil MG,von Ammon K,Cavazos E,et al.Tumours of the limbic and paralimbic systems[J].Acta Neurochir(Wien),1992,118(1-2):40~52.
[6] 邬立,陆斌,赵蕾,等.多模态神经导航及术中超声在高级别胶质瘤手术中的应用[J].中国神经精神疾病杂志,2022,48(8):463~468.
[7] Louis DN,Perry A,Wesseling P,et al.The 2021 WHO classification of tumors of the central nervous system:a summary[J].Neuro Oncol,2021,23(8):1231~1251.
[8] Kamali A, Milosavljevic S, Gandhi A, et al. The Cortico-Limbo-Thalamo-Cortical Circuits: An Update to the Original Papez Circuit of the Human Limbic System[J].Brain Topogr,2023,36(3):371~389.
[9] Lӧvblad KO,Schaller K.Surgical anatomy and functional connectivity of the limbic system[J].Neurosurg Focus,2009,27(2):E3.
[10] Verburg N,DE Witt Hamer PC.State-of-the-art imaging for glioma surgery[J].Neurosurg Rev,2021,44(3):1331~1343.
[11] Liu J,Li X,Leng X,et al.Effect of 3D Slicer Preoperative planning and intraoperative guidance with mobile Phone Virtual Reality Technology on Brain Glioma surgery[J].Contrast Media Mol Imaging.2022,24:2022:9627663.
[12] Cui M,Chen H,Sun G,et al.Combined use of multimodal techniques for the resection of glioblastoma involving corpus callosum[J].Acta Neurochir(Wien).2022,164(3):689~702.
[13] Orillac C,Stummer W,Orringer DA.Fluorescence Guidance and Intraoperative Adjuvants to Maximize Extent of Resection[J].Neurosurgery,2021,89(5):727~736.
[14] 马龙涛,张伟文,梅加明,等.多模态影像融合三维重建技术在颅内中央区脑膜瘤手术中的应用[J].中国现代神经疾病杂志,2022,22(3):187~194.
[15] 邬立,陆斌,赵蕾,等.多模态神经导航及术中超声在高级别胶质瘤手术中的应用[J].中国神经精神疾病杂志,2022,48(8):463~468.
[16] 贤俊民,陈凤月,孙晓妍,等.3D Slicer三维重建技术在脑功能区肿瘤手术治疗中的应用价值[J].中国临床神经外科杂志,2022,8(10):819~821.
[17] 刘璐,王春琳,刘家传,等.3D Slicer三维重建技术联合LSR监测在面肌痉挛微血管减压术中的应用[J].中国临床神经外科杂志,2023,28(3):160~163.
[18] 叶富跃,,杨堃,马春阳,等.3D-Slicer联合智能手机辅助定位下神经内镜血肿清除术对基底节区脑出血患者的应用价值研究[J].中国临床神经科学,2022,30(001):49-55.
[19] 李文华,师忠杰,王占祥,等.3D Slicer三维影像重建在颅内动脉瘤夹闭术中的应用[J].中国临床神经外科杂志,2022,27(008):646~649.
[20] 陈辉,闫昕,贺峰,等.3D Slicer软件在CR型脑外科手术机器人颅内病变活检中的应用[J].中华外科杂志,2023,61(1):61~65.
[21] 张楚.多模态神经导航在胶质瘤手术治疗的应用[J].中国微侵袭神经外科杂志,2020,25(2):94~96.
[22] 苏海波,张玲琼,陈保东,等.术中唤醒结合神经导航在脑功能区胶质瘤手术中的应用价值分析[J].中华神经医学杂志,2020,6(6):546~551.
[23] Gosal JS,Tiwari S,Sharma T,et al.Simulation of surgery for supratentorial gliomas in virtual reality using a 3D volume rendering technique:a poor man's neuronavigation[J].Neurosurg Focus,2021;51(2):E23.
[24] 杨佳,武有涛,董康,等.显微神经外科运用3D-Slicer自主构建脑干纤维束的相关研究[J].中华医学杂志,2020,100(8):604~609.
[25] 杨吉鹏,李晓瞳,王同聚,等.3DSlicer软件辅助经对侧纵裂入路显微手术治疗镰旁脑膜瘤[J].中国综合临床,2021,37(5):420~425.
[26] Mazzucchi E,La Rocca G,Hiepe P,et al.Intraoperative integration of Multimodal imaging to improve neuronavigation:A Technical note[J].World Neurosurg,2022,164:330~340.
[27] Zhou L,Wang W,Wei H,et al.Clinical application of 3D Slicer combined with Sina/MosoCam multimodal system in preoperative planning of brain lesions surgery[J].Sci Rep,2022;12(1):19258.
[28] Yuan E,Lin M,Han JS,et al.Commentary:early experience with virtual and synchronized augmented reality platform for preoperative planning and intraoperative navigation:a case series[J].Oper Neurosurg 2021,21(5):E457~E458.
[29] Mofatteh M,Mashayekhi MS,Arfaie S,et al.Augmented and virtual reality usage in awake craniotomy:a systematic review[J].Neurosurg Rev.2022;46(1):19.