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目的探讨颅脑分层重建融合手术辅助系统进行颅脑外科精准定位和微创手术的方法。方法采用影像处理系统Neurotech三维呈现11例癫痫手术患者的头皮、颅骨、颅脑的三维影像,以及脑表面沟回及血管形态、分布、走行信息,判断沟回功能。根据术前评估在三维脑表面上绘制切除范围,确定切除脑沟回,利用融合技术获取切除范围在头皮、颅骨、脑表面各层次的投影位置及范围。据此设计精准合理的头皮切口、颅骨钻孔、铣开范围及硬脑膜剪开范围和大小,精准暴露脑表面切除范围。术中根据三维沟回形态,辨识暴露沟回解剖及功能,结合重要血管及功能区进行手术操作的安全规划。结果 11例患者手术出血在160~250 ml,开颅过程均未伤及静脉窦及脑表面桥静脉,手术均未超出设计范围造成额外的脑功能损伤。术后恢复快,无贫血;术后癫痫Engle评分均为Ⅰ级。结论采用颅脑分层重建融合开颅辅助系统及术中沟回辨识方法,可以很好地帮助外科医师进行手术规划,构建神经外科的影像数字信息平台;实现脑外科手术的三维可视化,达到脑外科手术精准、微创和安全的目的。
Objective To investigate the methods of craniocerebral tomography reconstruction fusion surgery assisted system for precise localization of craniocerebral surgery and minimally invasive surgery. Methods Three-dimensional images of the scalp, skull and brain of eleven patients with epilepsy were presented by using the imaging system Neurotech in three dimensions. The dorsal surface of the brain and blood vessel morphology, distribution and movement information were analyzed to determine the function of ditch back. According to the preoperative assessment, the excision range was drawn on the surface of the three-dimensional brain and the excision of the sulci was confirmed. The projection position and the range of excision range at the scalp, skull and brain surface were obtained by fusion technique. According to the design of a reasonable and reasonable scalp incision, skull drilling, milling range and dural shear scope and size, accurate exposure of the brain surface resection range. Surgery based on three-dimensional ditch back shape, identify the anatomy and function of exposed ditch back, combined with important vascular and functional areas for surgical safety planning. Results The bleeding in operation was between 160 and 250 ml in 11 patients. None of the craniotomy resulted in injury to the sinus and cerebral venous bridge. The surgery did not exceed the design limits and caused additional brain damage. Postoperative recovery fast, no anemia; postoperative epilepsy Engle score were grade Ⅰ. Conclusions The cranial cerebral cortex reconstruction and craniotomy-assisted system and intraoperative recurrent dorsal recognition can help surgeons to perform surgical planning and construct neurosurgical imaging digital information platform. Three-dimensional visualization of brain surgery can be achieved. Surgical precision, minimally invasive and safe purpose.