根据DTI成像技术对脑周围神经纤维的重建来选择侧脑室穿刺的最佳深度与角度
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摘要
目的利用弥散张量成像(DTI)技术对脑神经纤维束重建,以此确定不同位置行侧脑室穿刺时的最佳角度与深度。同时为侧脑室穿刺提供一个最佳适宜的并可供选择的部位。方法选取120例成年人脑部扫描标本,其中90例标本来自CT扫描,另外30例来自DTI成像。在冠状面,矢状面和水平面进行测量,找出在侧脑室穿刺手术中最佳的穿刺角度与穿刺深度,同时对与侧脑室有关的位置关系和大小还有大脑两半球之间的不同与否进行了测量比对。结果大脑左右两半球差异无统计学意义(P>0.05)。侧脑室上缘与下缘的垂直距离是22.2±0.5mm,侧脑室长度为124.1±2.1mm。在额叶穿刺入路中,穿刺深度和角度分别是105.2mm至109.4mm和71.6±2.7°。在枕叶穿刺入路中,穿刺的深度和角度分别是90.7mm至111.4mm和15.3±1.8°。以上两种方法是传统穿刺入路途径利用CT和DTI技术所测量的结果。在顶叶穿刺入路中,穿刺的深度和角度分别为124.4mm至130.2mm和56.6±2.0度,此方法是根据DTI重建技术第一次新开创的一个侧脑室穿刺方法。结论最佳的顶叶穿刺将对脑部造成最小的损害同时最大程度保留功能的完整。DTI图像结合脑神经纤维束重建对侧脑室穿刺起到重大作用,可以帮助神经外科医生确定最佳的穿佳穿刺角度与深度。
Objective To find accurate angles and depths of lateral ventricle puncture using diffusion tensor imaging(DTI)reconstruction, as well as provide an optimized and alternative puncturing strategy. Method 90 CT images and 30 computed tomography(CT) images with DTI were analyzed. The measurements were performed on coronal, sagittal and horizontal planes. Some distances and angles were measured to determine the best angle and penetration depth during the puncture process. Important landmarks of the lateral ventricle were also measured, and a comparison of the differences between two hemispheres was also assessed. Results It showed that the vertical distance from the superior margin to inferior margin of the lateral ventricle was 22.2±0.5mm and the length was 124.1±2.1mm. In the frontal horn puncture approach, the penetration depth should be limited between 105.2mm and 109.4 mm, the angle should be 71.6±2.7degree. During the occipital horn puncture approach, puncturing depth was from 90.7 mm to 111.4mm, and angle was 15.3±1.8degree. Through the parietal lobe puncture approach, which was firstly brought out in this study, the puncturing length should be 124.4mm to 130.2mm and angle was 56.6±2.0degree. Conclusion The traditional recommended protocol of lateral ventricle puncture is not accurate, the refined lateral ventricle puncture protocol established in this study will reduce injury and remain function in the greatest extent. A DTI imaging examination combining with nerve fibers reconstruction were strongly recommended before lateral ventricle puncture, which will help neurosurgeons to determine the best puncturing angles and depth.
Objective To find accurate angles and depths of lateral ventricle puncture using diffusion tensor imaging(DTI)reconstruction, as well as provide an optimized and alternative puncturing strategy. Method 90 CT images and 30 computed tomography(CT) images with DTI were analyzed. The measurements were performed on coronal, sagittal and horizontal planes. Some distances and angles were measured to determine the best angle and penetration depth during the puncture process. Important landmarks of the lateral ventricle were also measured, and a comparison of the differences between two hemispheres was also assessed. Results It showed that the vertical distance from the superior margin to inferior margin of the lateral ventricle was 22.2±0.5mm and the length was 124.1±2.1mm. In the frontal horn puncture approach, the penetration depth should be limited between 105.2mm and 109.4 mm, the angle should be 71.6±2.7degree. During the occipital horn puncture approach, puncturing depth was from 90.7 mm to 111.4mm, and angle was 15.3±1.8degree. Through the parietal lobe puncture approach, which was firstly brought out in this study, the puncturing length should be 124.4mm to 130.2mm and angle was 56.6±2.0degree. Conclusion The traditional recommended protocol of lateral ventricle puncture is not accurate, the refined lateral ventricle puncture protocol established in this study will reduce injury and remain function in the greatest extent. A DTI imaging examination combining with nerve fibers reconstruction were strongly recommended before lateral ventricle puncture, which will help neurosurgeons to determine the best puncturing angles and depth.
引文
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[13]郑燕婷,基于DTI的首发抑郁症患者脑白质微观结构的研究[D].广州中医药大学,2017.
[2]Jia L,Su L,Sun W,et al.Morphological study of transpterional-insula approach using volume rendering[J].J Craniofac Surg,2012.23(6):1893-1894.
[3]Sun W,Jia L,Dong Y,et al.Morphological study of surgical approach by superior temporal sulcus-temporal horn of lateral ventricle approach using volume rendering[J].J Craniofac Surg,2014.25(2):611-613.
[4]Surer E,Rossic,Becker AS,et al.Cardiac-gated intravoxel incoherent motion diffusion-weighted magnetic resonance imaging for the investigation of intracranial cerebrospinal fluid dynamics in the lateral ventricle:a feasibility study[J].Neuroradiology,2018.60(4):413-419.
[5]Wu LM,Bao JR,Zheng LH,et al.Initial experience of catheter ablation of ventricular tachycardia originate from endocardium via direct ventricle puncture access in patients underwent mechanical valve implantation[J].Zhonghua xin xue guan bing za zhi,2018.46(3):p.213-217.
[6]Zhu W,Gao Y,Wan J,et al.Changes in motor function,cognition,and emotion-related behavior after right hemispheric intracerebral hemorrhage in various brain regions of mouse[J].Brain Behav Iimmun,2018.69:568-581.
[7]蔡建新,彭如臣,弥散张量磁共振成像方法概述[J].医学影像学杂志,2007,7(10):1119-1122.
[8]程兆兴,梁冠华,黄晓雯,等.侧脑室穿刺持续引流在婴幼儿重度脑室出血中的应用研究[J].心脑血管病防治,2017,17(3):169-171.
[9]罗自勉,宋治,付林,等.双侧脑室引流联合脑脊液置换治疗重型脑室出血的临床研究[J].中国急救医学,2007,8(3):334-336.
[10]邱明国,王健,谢兵,等.应用DTI技术对人脑白质纤维束的初步研究[J].医用生物力学,2006,21(3):192-197.
[11]徐茂法,张立新,杨子健,等.颅内压监测下侧脑室穿刺脑室外引流术治疗脑室内出血的临床研究[J].浙江医学,2015,37(8):664-666.
[12]张卫东,李家尧,梁碧玲,弥散张量成像对颅脑肿瘤与相邻脑白质纤维束解剖关系的评价[J].中国医学影像学杂志,2007,15(1):1-4.
[13]郑燕婷,基于DTI的首发抑郁症患者脑白质微观结构的研究[D].广州中医药大学,2017.