颅神经示踪重建在前庭神经鞘瘤手术中的应用研究

发布时间：2018-01-22 15:23

本文关键词： 颅神经弥散张量成像纤维束示踪成像前庭神经鞘瘤　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的颅神经的三维成像在当今是一项具有重大意义的技术,它使得神经外科医师能够在术前评估颅神经受压后的移位及形态学改变。在本研究中,作者尝试应用弥散张量成像技术对健康受试者、颅底占位性病变患者进行相关颅神经三维重建,验证其可能性,并通过统计学分析探讨此技术在前庭神经鞘瘤手术中的应用价值。方法在3.0T高场强核磁共振条件下,应用王维快速扰相梯度回波序列(3D fast spoiled gradient-echo sequence,3D-FSPGR),循环相位稳态采集快速成像(Fast Imaging Empolying Steady State Acquisition, FIESTA),弥散张量成像(Diffusion tensor imaging, DTI)这三种不同的特殊扫描序列对所有受试者进行初步扫描。DTI资料整合入3D Slicer软件来进行纤维束示踪和重建,在软件中结合3D-FSPGR或FIESTA图像完成颅神经走形和位置的定位。典型颅底占位性病变病例及前庭神经鞘瘤病例,术前进行相关颅神经示踪重建及肿瘤体的三维重建,以此展示颅神经与周围病变之间的毗邻、包裹、侵袭关系。术中结合显微镜下观察和、或神经电生理监测记录、核实的相关颅神经及面神经的位置。结果通过弥散张量成像技术,可确定健康受试者、以及典型颅底病变、前庭神经鞘瘤患者的病变相关颅神经的位置、走形,及形态改变。面神经呈现为良好的三维重建像,尤其视交叉后部也成像清晰。三叉神经(100%)出脑干最远端可达半月神经节,近端达出脑干区。外展神经(85%)脑池段成像良好,但Dorello管内纤维束无法示踪。面听神经(90%)成一束神经纤维束复合体,脑池段至内听道内重建良好。后组颅神经纤维束较其他明显纤细,迷走神经、舌下神经仅能示踪重建出少量神经纤维。10例颅底占位性病变病例中,相关颅神经与占位性病变的三维空间关系通过肿瘤三维重建与颅神经纤维示踪得以完整呈现,受累及的三叉神经、外展神经、面听神经等有不同程度的移位,其准确性经过手术验证无误。21例前庭神经鞘瘤病例中,19例患者的面神经纤维束(19/21,90.5%),从脑干端到内听道的走形及解剖位置均可得到完好的展现,面神经桥小脑角段相对于肿瘤的位置,17例与术中显微镜下及神经电生理监测相符合(17/19,89.5%)。结论依托与弥散张量成像技术及3D Slicer软件,颅底相关的部分颅神经三维重建在正常或是病例状态下是切实可行的。这项技术能够在术前判断颅底颅神经与周边病变的毗邻、包裹、侵袭关系,尤其可完善前庭神经鞘瘤手术术前计划,指导术者术中精准操作,具有良好的临床应用前景。
[Abstract]:Objective Three-dimensional imaging of cranial nerves is a significant technique, which enables neurosurgeons to evaluate the displacement and morphological changes of cranial nerves before operation. The authors attempted to use diffusive Zhang Liang imaging technique to reconstruct the cranial nerves in healthy subjects and patients with space-occupying lesions of the skull base. The application value of this technique in vestibular neurilemmoma surgery was discussed by statistical analysis. Methods under the condition of 3.0T high field nuclear magnetic resonance. The 3D fast spoiled gradient-echo sequence (3D-FSPGR) was applied to Wang Wei's fast disturbed phase gradient echo sequence. Fast Imaging Empolying Steady State requirements (Fiesta). Diffused tensor imaging with diffusion Zhang Liang. DTI) these three different special scanning sequences performed initial scanning. DTI data were integrated into 3D Slicer software for tracer and reconstruction of fiber bundles. 3D-FSPGR or FIESTA images were used to locate the shape and position of cranial nerve. The typical lesions of skull base and vestibular schwannoma were found. Preoperative cranial nerve tracer reconstruction and three-dimensional reconstruction of the tumor body were performed to show the relationship between the cranial nerve and the surrounding lesions. The location of the related cranial and facial nerves was verified by electrophysiological monitoring records. Results by means of diffusive Zhang Liang imaging technique, healthy subjects and typical skull base lesions could be identified. The location, shape, and morphology of the cranial nerve associated with the lesions in patients with vestibular schwannoma. The facial nerve presented a good three-dimensional reconstruction image. In particular, the posterior part of optic chiasma is also clear. The trigeminal nerve is 100) the farthest end of the brain stem can reach to the ganglion of the semilunar, the proximal end to the brain stem area and the abducent nerve 85) the cistern segment imaging is good. However, the fiber bundle in the Dorello tube could not be traced. The facial auditory nerve (90) formed a bundle of nerve fiber bundle complex, and the reconstruction from the cisternal segment to the internal auditory canal was good. The posterior cranial nerve fiber bundle was significantly thinner than the other ones. Vagus nerve, hypoglossal nerve can only be traced to reconstruct a small amount of nerve fibers. The three-dimensional relationship between cranial nerve and space-occupying lesion can be completely presented by three-dimensional reconstruction of tumor and tracer of cranial nerve fiber. The involved trigeminal nerve, abducent nerve, facial and acoustic nerve have different degrees of displacement. Its accuracy was proved correct by operation. 19 of 21 patients with vestibular schwannoma had facial nerve fiber bundle 19 / 21 / 90.5). The shape and anatomic position from the end of the brain stem to the internal auditory canal can be well displayed, and the position of the cerebellopontine angle relative to the tumor. 17 cases were in agreement with intraoperative microscope and electrophysiologic monitoring. Conclusion relying on and diffusing Zhang Liang imaging technology and 3D Slicer software. Three-dimensional reconstruction of cranial nerve associated with the skull base is feasible in normal or case status. This technique can determine the relationship between cranial nerve and peripheral lesions before operation. Especially, it can perfect the preoperative plan of vestibular neurilemmoma operation and guide the accurate operation during operation. It has a good clinical application prospect.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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