摘要
目的评估基于多模态导航的虚拟现实技术（MNVR）在脑功能区病变穿刺手术中的应用价值。方法2016年1月至2017年1月共20例脑功能区病变患者在解放军总医院神经外科接受虚拟现实技术辅助下的活体组织检查术。男性11例，女性9例，年龄（38±20）岁（范围：10～76岁）。20例患者病变均位于功能区。术前术者在MNVR帮助下设计和完善穿刺计划，术中术者在多模态导航引导下按照预设路径完成穿刺手术。术中MRI用于反馈穿刺部位的准确性和发现术中出血等并发症。记录手术前后患者神经功能状态、术中穿刺准确性、并发症情况、手术结果和术后病理等指标。采用Wilcoxon秩和检验比较活检前后神经功能评分。结果借助MNVR，术者于术前发现9例（45%）最初设计的穿刺路径可能损伤毗邻的功能结构。术中所有病例的活检穿刺路径和靶点均成功避开功能区。活检前与术后2周的神经功能Karnofsky评分无明显差异（Z＝－1.000，P＝0.317）。20例患者共进行21次术中扫描，术中MRI协助纠正了1例错误的取材位点并发现了1例术中穿刺点出血，2例患者均得到及时有效的处理。20例患者无MNVR相关的不良事件和并发症。结论基于多模态导航的MNVR辅助的脑功能区病变穿刺术是一种安全、新型、有效的活体组织检查方式，可减少手术相关的神经功能损伤。
ObjectiveTo investigate the clinical value of multimodal navigation-based virtual reality （MNVR） in the needle biopsy of intracranial eloquent lesions.MethodsFrom January 2016 to January 2017, 20 patients with intracranial deep-seated lesions involving eloquent brain areas underwent MNVR-aided needle biopsy at Department of Neurosurgery, People′s Liberation Army General Hospital. Preoperatively, MNVR was used to propose and revise the biopsy planning. Intraoperatively, navigation helped trajectory avoid the eloquent structures. Intraoperative MRI （iMRI） was performed to prove the biopsy accuracy and detect the intraoperative complications. Perioperative neurological status, iMRI findings, intraoprative complications, surgical outcome and pathological diagnosis were recorded. Wilcoxon rank-sum test was conducted to compare the preoperative and postoperative neurological scores.ResultsMNVR helped revised 45%（9/20） initial biopsy trajectories, which would probably injury the nearby eloquent structures. Navigation helped biopsy trajectories spare the eloquent structures during the operation. No statistical difference was found between postoperative and preoperative neurological status, despite all the lesions were adjacent to eloquent areas. Additionally, 20 patients totally received 21 iMRI scanning. iMRI helped revise incorrect biopsy site in one case and detected intraoperative hemorrhage in another case, both of cases were treated immediately and effectively. No MNVR related adverse events and complications occurred.ConclusionsMNVR-aided needle biopsy of intracranial eloquent lesions is a safe, novel and efficient biopsy modality. This technique is helpful to reduce the incidence of surgery related neurological deficits.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2018年第3期231-236,共6页
Chinese Journal of Surgery
基金
解放军总医院科技创新苗圃基金项目（15KMM19）
解放军总医院临床科研扶持基金（2016FC-TSYS-1023）
关键词
神经导航
活组织检查
外科手术
微创性
Neuronavigation
Biopsy
Surgical procedures, minimally invasive
