三维可视化模型指导中央区镰旁脑膜瘤手术的研究
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摘要
目的探讨三维可视化模型指导显微手术切除中央区镰旁脑膜瘤的效果。方法回顾性分析2015年1月至2018年1月在三维可视化模型指导下,显微手术切除的20例中央区镰旁脑膜瘤患者的临床资料。结果在三维可视化模型下,所有患者的肿瘤与颅内重要静脉的关系均能清晰显示;术中所见与术前检查结果相符合,术中对重要静脉的保护完全。20例患者的中央区镰旁脑膜瘤均SimpsonⅠ级切除。术后3例患者出现一过性肢体肌力下降,后恢复;无死亡病例。随访6～42个月未见肿瘤复发。结论三维可视化模型可清晰显示大脑镰旁脑膜瘤与周围静脉的关系。采用三维可视化模型制订个体化手术入路,有利于肿瘤的全切,避免或减少重要引流静脉的损伤,减少并发症及改善患者的预后。
Objective To explore the effect of microsurgical resection of falcine meningioma in the central region with the guidance of 3D visualization model. Methods The clinical data of 20 patients with falx meningioma in the central region who underwent microsurgical resection under the guidance of three-dimensional visual model from January 2015 to January 2018 were analyzed retrospectively. Results The relationship between tumor and intracranial important veins could be clearly displayed in all cases on the three-dimensional visualization model. The intraoperative findings were consistent with the preoperative findings. The important vein protection was completed during the operation. 20 patients with falx meningioma in the central region underwent SimpsonⅠ-grade resection. After operation,3 patients had a lower limb muscle strength decline and recovered. The follow-up from 6 to 42 months showed there were no death and no tumor recurrence in these cases. Conclusions The three-dimensional visualization model can clearly demonstrate the relationship between the cerebral falx meningioma and the surrounding veins. 3 D visualization model can help to complete resection of the tumor in a proper approach,which can avoid or reduce the damage of the important venous drainage and improve the prognosis of patients.
Objective To explore the effect of microsurgical resection of falcine meningioma in the central region with the guidance of 3D visualization model. Methods The clinical data of 20 patients with falx meningioma in the central region who underwent microsurgical resection under the guidance of three-dimensional visual model from January 2015 to January 2018 were analyzed retrospectively. Results The relationship between tumor and intracranial important veins could be clearly displayed in all cases on the three-dimensional visualization model. The intraoperative findings were consistent with the preoperative findings. The important vein protection was completed during the operation. 20 patients with falx meningioma in the central region underwent SimpsonⅠ-grade resection. After operation,3 patients had a lower limb muscle strength decline and recovered. The follow-up from 6 to 42 months showed there were no death and no tumor recurrence in these cases. Conclusions The three-dimensional visualization model can clearly demonstrate the relationship between the cerebral falx meningioma and the surrounding veins. 3 D visualization model can help to complete resection of the tumor in a proper approach,which can avoid or reduce the damage of the important venous drainage and improve the prognosis of patients.
引文
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[13]Tomasello F,Conti A,Cardali S,et al.Venous preservation-guided resection:a changing paradigm in parasagittal meningioma surgery[J].J Neurosurg,2013,119:74.
[14]Della Puppa A,Rustemi O,Gioffre GA,et al.Application of indocyanine green video angiography in parasagittal meningioma surgery[J].Neurosurg Focus,2014,36:E13.
[15]Barajas J,Sughrue ME,Mcdermott MW.Large falcine meningioma fed by callosomarginal branch successfully removed following contralateral interhemispheric approach[J].J Neurooncol,2010,97:127.
[16]Roser F,Rigante L.The endoscope-assisted contralateral paramedian approach to large falcine meningiomas[J].Acta Neurochir(Wien),2018,160:79.
[17]Sato M,Tateishi K,Murata H,et al.Three-dimensional multimodality fusion imaging as an educational and planning tool for deep-seated meningiomas[J].Br J Neurosurg,2018,32:1.
[18]李国峰,侯文仲,曾敏敏,等.大脑镰及矢状窦旁脑膜瘤显微手术治疗的研究[J].临床神经外科杂志,2016,13:252.
[19]唐田,古善智,李国文,等.巨型富血供脑膜瘤术前栓塞的临床应用[J].介入放射学杂志,2017,26:355.
[2]Ochi T,Saito N.Systematic review of complications for proper informed consent(7)surgery for convexity/parasagittal/falx meningiomas[J].No Shinkei Geka,2013,41:361.
[3]李国峰,侯文仲,曾敏敏,等.大脑镰及矢状窦旁脑膜瘤显微手术治疗的研究[J].临床神经外科杂志,2016,13:252.
[4]Murrone D,De Paulis D,Di Norcia V,et al.Surgical managemen of falcine meningiomas:Experience of 95 patients[J].J Clin Neurosci,2017,37:25.
[5]Magill ST,Theodosopoulos PV,Mcdermott MW.Resection of falx and parasagittal meningioma:complication avoidance[J].JNeurooncol,2016,130:253.
[6]Wang SS,Ying JB,Wei LF,et al.Effects of parasagitta meningiomas on intracranial venous circulation assessed by the virtual reality technology[J].Int J Clin Exp Med,2015,8:12706.
[7]刘宇清,黄绳跃,何炳蔚,等.3D打印技术在大脑镰旁脑膜瘤切除术中的初步应用[J].中国全科医学,2016,19:2953.
[8]何升学,张岩松,刘宏毅,等.显微手术切除脑中央区双侧巨大脑膜瘤[J].中华神经外科杂志,2011,27:391.
[9]Saloner D,Uzelac A,Hetts S,et al.Modern meningioma imaging techniques[J].J Neurooncol,2010,99:333.
[10]Yi ZQ,Li L,Mo DP,et al.Preoperative surgical planning and simulation of complex cranial base tumors in virtual reality[J].Chin Med J,2008,121:1134.
[11]Deng WS,Zhou XY,Li Z,et al.Microsurgical treatment for central gyrus region meningioma with epilepsy as primary symptom[J].JCraniofac Surg,2014,25:1773.
[12]Nowak A,Dziedzic T,Czernicki T,et al.Surgical treatment of parasagittal and falcine meningiomas invading the superior sagittal sinus[J].Neurol Neurochir Pol,2014,48:174.
[13]Tomasello F,Conti A,Cardali S,et al.Venous preservation-guided resection:a changing paradigm in parasagittal meningioma surgery[J].J Neurosurg,2013,119:74.
[14]Della Puppa A,Rustemi O,Gioffre GA,et al.Application of indocyanine green video angiography in parasagittal meningioma surgery[J].Neurosurg Focus,2014,36:E13.
[15]Barajas J,Sughrue ME,Mcdermott MW.Large falcine meningioma fed by callosomarginal branch successfully removed following contralateral interhemispheric approach[J].J Neurooncol,2010,97:127.
[16]Roser F,Rigante L.The endoscope-assisted contralateral paramedian approach to large falcine meningiomas[J].Acta Neurochir(Wien),2018,160:79.
[17]Sato M,Tateishi K,Murata H,et al.Three-dimensional multimodality fusion imaging as an educational and planning tool for deep-seated meningiomas[J].Br J Neurosurg,2018,32:1.
[18]李国峰,侯文仲,曾敏敏,等.大脑镰及矢状窦旁脑膜瘤显微手术治疗的研究[J].临床神经外科杂志,2016,13:252.
[19]唐田,古善智,李国文,等.巨型富血供脑膜瘤术前栓塞的临床应用[J].介入放射学杂志,2017,26:355.