Preoperative surgical planning for intracranial meningioma resection by virtual reality

Background  The Dextroscope system by Volume Interactions (Singapore) had been applied to minimally invasive neurosurgery in many units. This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects. In the paper, we explored its values in pre-operation surgical planning for intracranial meningiomas resection.

Methods  Brain computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT, MRI and magnetic resonance angiography (MRA) were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas. All these data were transferred to Dextroscope virtual reality system, and reconstructed. Then meningiomas, skull base, brain tissue, drainage vein and cerebral arteries were displayed within the system, and their anatomic relationships were evaluated. Also, the simulation operations were performed.

Results  For parasagittal and falcine meningiomas, the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system. For anterior skull base and sphenoid ridge meningiomas, the relationships of tumor with bilateral internal carotid arteries, anterior cerebral arteries, middle cerebral arteries and skull base were vividly displayed within the virtual reality system. Surgical planning and simulation operation of all cases were performed as well. The real operations of all patients were conducted according to the simulation with well outcomes.

Conclusions  According to the virtual reality planning, neurosurgeons could get more anatomic information about meningioma and its surrounding structures, especially important vessels, and choose the best approach for tumor resection, which would lead to better prognosis for patients.

     

磁共振血管成像、虚拟现实技术在蝶骨嵴脑膜瘤术前计划中的应用

目的探讨磁共振血管成像、虚拟现实技术在蝶骨嵴脑膜瘤术前计划中的应用。方法 10例蝶骨嵴脑膜瘤患者术前行头颅CT、MRI和MRA等检查,然后将这些数据输入新加坡Volume Interactions公司研发的Dextroscope术前计划系统,在虚拟现实环境中对肿瘤及其周围组织进行重建等处理,构建出立体的空间三维图像;再利用系统工具对肿瘤及其周围组织进行观察、手术模拟等操作,在术前充分获得肿瘤、颅底骨质及神经、血管等相互关系的信息,制定详细的手术计划,并与术中情况进行对照。结果 10例患者均成功实现了三维立体虚拟现实影像的重建,按照术前计划进行手术,术中情况与术前模拟基本一致,符合率达100%。10例肿瘤均全切,取得良好效果,术后患者无后遗症。结论头颅MRA结合Dextro-scope术前计划系统反映肿瘤及其邻近组织的解剖结构信息,为术前制定手术方案提供帮助,有助于提高手术安全性与病灶切除率,改善患者预后。     

Preoperative surgical planning and simulation of complex cranial base tumors in virtual reality

The extremely complex anatomic relationships among bone, tumor, blood vessels and cranial nervesremains a big challenge for cranial base tumor surgery. Therefore, a good understanding of the patient specific anatomy and a preoperative planning are helpful and crucial for the neurosurgeons. Three dimensional （3-D） visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.     

虚拟影像手术计划系统在颅内动脉瘤诊断中的应用

目的 探讨虚拟影像手术计划系统在颅内动脉瘤诊断中的应用价值.方法 选择54例经3D-CTA检查确诊的颅内动脉瘤患者,通过虚拟影像手术计划系统对原始CT图像进行三维重建,获得颅骨及脑血管的三维立体虚拟影像资料.对动脉瘤的位置、大小、形态及毗邻结构进行多角度观察和测量.利用系统的模拟手术工具对每例患者进行手术计划和模拟手术操作.结果 54例均成功地进行了三维立体虚拟影像重建和相关操作.该系统形成的虚拟图像清晰、逼真,可非常直观地显示动脉瘤的位置、大小、与载瘤动脉和颅骨的关系.利用该系统可进行简单的手术模拟操作.结论 虚拟影像手术计划系统可作为颅内动脉瘤的辅助诊断工具,利用该系统可获得更详细的动脉瘤影像学信息.     

Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms

Background The virtual reality （VR） system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional （3-D） image similarly to manipulate a real object.it was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms.This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms.Methods A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography （3D-DSA） or VR-based computed tomography angiographies （CTA）.The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels.The data of observation and measurements were compared between VR image and 3D-DSA image.All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system.Results There were 28 aneurysms detected in VR system and 3D-DSA system.The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull.The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system.This VR system also could simulate simple surgical procedures and surgical environments.Conclusions The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA.It significantly enhances the chosen therapeutic strategy of cerebral aneurysms.     

虚拟现实系统对脑动脉瘤诊断和治疗计划的作用

Background The Virtual Reality (VR) system can provide the neurosurgeon to intuitively interact with and manipulate the 3-D image similarly to manipulate a real object. It was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms. We try to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms. Methods We enrolled 24 cases of cerebral aneurysms from2006 to 2008, which diagnosed by three-dimensional digital subtraction angiography (3D-DSA) or VR based Computed tomography angiographies (CTA). The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels. The data of observation and measurements were compared between VR image and 3D-DSA image. All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system. Results There were 28 aneurysms detected in VR system and 3D-DSA system. The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull. The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were coincidence between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system. This VR system also could simulate simple surgical procedures and surgical environments. Conclusions We believe the VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSAsystem and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA, and it significantly enhances the chosen therapeutic strategy of cerebral aneurysms.     

虚拟与现实结合的心电图软件的构建

结合实践，提出了由医学专家给出医学专业框架，联合计算机专家研制开发诊断学虚拟和现实结合的心电图软件。并介绍了该软件系统采用临床心电图机操作的方式，把真实心电图镜像处理后输出，先给出动态图形，然后冻结图形以便察看的过程，同时指出该软件用于培养和训练医学生及青年医师具有良好的智能性、互动性和可操作性。     

三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术中的应用

目的 探讨利用Deepinsinght 软件进行三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术中的应用价值。方法 回顾性分析2018 年1～12 月我院行胸腔镜解剖性肺段切除术治疗的22 例术前疑似早期肺癌患者的临床资料。术前将胸部增强CT 检查的断层二维图像信息以DICOM 格式导入Deepinsinght 系统中进行三维重建及虚拟手术规划实施精准肺段切除。观察指标：①术前三维重建及虚拟手术规划情况;②术中及术后情况。③随访情况。结果 ①术前三维重建及虚拟手术规划情况：22 例患者术前均完成三维重建和虚拟手术规划;②术中及术后情况：22 例患者均顺利行胸腔镜解剖性肺段切除术,无中转开胸。22 例患者手术时间为（115.05±27.54）min,术中出血量为（78.64±16.14）mL,术后拔管时间为（3.55±1.06）d,术后住院时间为（7.27±2.62）d。术后发生肺部感染2 例,发生肺动脉栓塞1 例,均经保守治疗后痊愈。术后肿瘤TNM 分期为：良性肿瘤1 例,0 期9 例,IA 期11 例、IB 期2 例。三维重建和虚拟手术规划评估肿瘤性质的准确率为95.5%（21/22）。③随访情况：随访期间所有患者均未发生局部复发、远处转移及死亡情况。结论 应用三维重建及虚拟手术规划能实现精准肺段切除,可提高胸腔镜解剖性肺段切除术的准确性和安全性。     

术前影像预测脑膜瘤手术分离度的前瞻性研究

目的探讨脑膜瘤术前影像学指标在预测脑膜瘤手术分离度中的价值。方法前瞻性研究43例脑膜瘤术前影像学表现与显微手术分离度的相关性。结果瘤周水肿、血供类型、皮质浸润和MRIT2WI信号强度与手术分离度有关(P<0.05);而肿瘤的部位、大小、边界、强化情况、钙化、囊变、脑膜尾征、邻近骨改变与手术分离度无关(P>0.05)。结论术前影像资料提供的瘤周水肿、血供类型、皮质浸润和MRIT2WI信号强度可预测脑膜瘤手术分离度。     

Combined application of virtual imaging techniques and three-dimensional computed tomographic angiography in diagnosing intracranial aneurysms

Background The diagnostic value of virtual imaging combined with three-dimensional computed tomographic angiography （3D-CTA） for intracranial aneurysms has not been fully elucidated yet. This study aimed to evaluate the value of combined application of virtual imaging techniques and 3D-CTA in diagnosing patients with aneurismal subarachnoid hemorrhage （SAH） at the acute stage. Methods Eighty patients with non-traumatic SAH received 3D-CTA examinations. The raw CT data of these patients were reconstructed and transferred into the 3D mode through the surgical plan system based on virtual reality （VR） image, and the 3D virtual images of skulls and brain blood vessels were acquired. The location, size and shape of aneurysms and their anatomic relationship with adjacent tissues were measured from many points of view. Results Seventy-three aneurysms were detected in 68 of the 80 patients, but 2 aneurysms were detected in 2 of the 5 patients who had been found free of aneurysms previously and had received 3D-CTA examinations for a second time one month later. The 3D virtual images produced by the virtual imaging system were clear and vivid, and they could reveal the location and size of the aneurysm and its relations to the parent artery and skull directly. Conclusions The imaging of 3D-CTA is convenient, reliable and fast in diagnosing intracranial aneurysms and can be regarded as the first choice for the diagnosis and treatment of ruptured intracranial aneurysms. Combined with the surgical plan system based on the VR image, 3D-CTA may obtain more imaging information about aneurysms.     

基于机器学习的脑膜瘤术后短期结局预测模型

目的基于脑膜瘤患者的术前真实世界临床变量,使用机器学习算法构建术后短期预后不良的预测模型。方法回顾性地收集了2011年9月—2022年3月在同济大学附属第十人民医院神经外科进行手术切除治疗的脑膜瘤患者的临床变量和出院时的格拉斯哥预后评分（Glasgow outcome scale, GOS）。使用GOS评分将患者进行分组,≤3级的患者定义为预后不良。将患者按照7∶3的比例随机分为训练集和验证集,分别使用支持向量机（support vector machines, SVM）、随机森林（random forest, RF）、梯度提升（gradient boosting, GB）、自适应增强（adaptive boosting, AdaBoost）和多层感知器（multilayer perceptron, MLP）算法在训练集上进行建模,使用验证集检验模型的预测能力。针对预测能力较好的模型使用Shapley Additive Explanations（SHAP）算法进行模型解释。结果收集了424个脑膜瘤患者的42种临床特征数据和GOS评分,筛选后有23种临床特征纳入了训练集的机器学习模型构建。基于不同算法的机器学习模型在验证集中的预测能力表现不同,AdaBoost的表现最优,曲线下面积为0.925。SHAP算法提示在AdaBoost模型中,脑膜瘤最大径、入院时血压、术前的钙离子浓度、血尿素浓度和血肌酐浓度对模型决策的贡献度较大,提示这些术前临床特征与脑膜瘤患者术后短期预后存在相关性。结论本研究使用真实世界大数据,构建了一种可解释的基于AdaBoost算法的机器学习模型,在预测脑膜瘤患者术后短期不良结局上具有良好的效果。     

浅谈医学教育中虚拟现实技术的应用发展

随着计算机技术和多媒体技术的飞速发展,虚拟现实技术已逐渐应用于社会的各个领域。目前已进入教育领域,涉及高等教育的各个学科。作为一门新兴的学科,虚拟现实技术在医学教育中的应用研究也备受瞩目。文章从探索阶段、实用阶段、快速发展阶段对虚拟现实技术在医学教育中的应用发展进行了探讨,并对其应用前景进行了展望。     

功能学虚拟实验软件的开发与应用

医学虚拟实验是指在无实验动物和无实验对象的情况下,利用计算机虚拟现实模拟医学实验的全部操作过程.计算机的虚拟现实技术(virtual reality technology,VRT)和静态虚拟现实技术(quicktime virtual reality technology,QTVRT)已经应用到医学实验教学和医疗操作培训的各个领域,为实验教学与培训模式转化、变革提供了技术支撑.本文简单介绍了功能学虚拟实验软件开发的技术思路和体会.     

虚拟现实技术联合案例教学在本科生前沿外科手术队基本技能教学中的应用

目的 探索虚拟现实技术联合案例教学在本科生前沿外科手术队（forward surgical team, FST）基本技能教学中的应用效果。方法 选取2020年1月至2021年1月在海军军医大学第二附属医院进行临床实习的42名本科学员作为研究对象,随机分为试验组和对照组,分别采用虚拟现实技术联合案例教学及传统教学进行FST基本技能教学。通过问卷调查和考核评估的方式评价教学效果。采用SPSS 23.0进行t检验、卡方检验或Fisher确切概率法。结果 问卷调查显示,两组学员对教学的整体满意度、学习中理解和实践情况、学习后记忆效果评分相近;而在理论知识提升、技能操作提升、分析解决实际问题能力的提高以及学习兴趣和积极性、学习注意力、学习互动等方面,试验组的评分优于对照组[（4.33±0.26） vs. （4.17±0.21）,（4.32±0.22） vs. （4.12±0.27）,（4.04±0.37） vs.（3.69±0.38）,（4.34±0.28） vs. （3.92±0.43）,（4.21±0.35） vs. （3.81±0.34）,（4.18±0.29） vs.（4.01±0.21）,P<0.05]。考核结果显示,试验组总评得分明显高于对照组[（85.96±5.35） vs. （77.03±7.29）,P<0.001],其中理论基础得分及技能操作得分均明显更优[（28.25±4.74） vs. （25.01±5.37）,（57.47±4.96） vs. （51.99±8.03）,P<0.05]。结论 虚拟现实技术联合案例教学对于本科生FST基本技能教学有独特优势,可进一步开展相关研究及应用。     

基于多模态功能神经导航的虚拟现实及增强现实技术在神经外科教学中的应用

神经解剖复杂、难以掌握。手术操作相对较难,对精细程度及微创的要求高,且其解剖及手术教学培训的手段有限。虚拟现实技术在神经外科临床及教学中已有报道,而增强现实技术在神经外科教学中的应用则少有报道。文章介绍了基于多模态功能神经导航计划平台,实现虚拟现实及增强现实。同时,详细阐述了其在神经外科手术及教学中的作用、优势及其应用前景。     

虚拟现实技术在Web课件中的应用

通过对虚拟现实技术在实际教学中的应用研究,概括了Web课件中虚拟现实技术的应用特点,并分别介绍了Web课件中的二维虚拟技术、三维虚拟技术、VRML技术和Flash虚拟技术,同时结合实例,对每种虚拟效果的制作过程做了讲解,指出了在Web课件中应用虚拟现实技术时应注意的事项.     

虚拟现实技术在心理焦虑治疗中的应用

目前很多学生存在心理焦虑现象，这不仅影响他们的学习成绩，而且影响着他们的身心健康。传统的方法在治疗心理焦虑时效果会受到患者个人因素的影响，利用虚拟现实技术设计一套治疗方案，可以降低在治疗过程中患者个人因素的参与，增加患者对客观因素的感受，从而提高治疗效果。     

虚拟现实技术在教学中的应用模式探析

在介绍虚拟现实技术及其基本特点的基础上,提出了虚拟现实教学三种主要的教学模式：虚拟情境教学、模拟仿真教学和超现实环境教学模式.同时指出它为教学的创新提供了新的空间、平台和可能性,丰富了教学的实践形式和多样性.     

虚拟现实技术在医学教育应用中的新进展

在分析虚拟现实技术和医学教育特点,以及虚拟现实技术在医学教育中优势的基础上,介绍了虚拟学习理论进展、虚拟学习评价的研究成果、虚拟学习效果检验研究以及医学虚拟学习系统新案例.     

虚拟现实技术在组胚学教学中的应用

从虚拟现实技术的概念、分类入手,根据当前虚拟现实的主要应用形式,从虚拟实验室、虚拟教学及远程实验指导等方面介绍了国内外虚拟现实技术在组胚学上的应用情况,为我国虚拟现实技术的应用与发展提供借鉴与参考。