MRI与DSA三维影像数据输入神经导航融合行脑深部血管病直视手术的探讨

目的 探讨MRI与DSA三维影像数据输入神经导航融合在脑深部血管病手术中的应用价值。方法 回顾性分析广州军区武汉总医院神经外科2013年8月至2015年3月共使用MRI与DSA三维影像数据输入神经导航融合行脑深部直视显微手术治疗的5例脑血管病患者的临床资料，其中烟雾病合并脉络膜后动脉末梢分支动脉瘤1例，动静脉畸形合并静脉瘤2例，大脑前动脉A2段与腁周动脉外伤性多发假性动脉瘤1例，前颅窝底硬脑膜动静脉瘘1例。术前Hunt-Hess分级Ⅱ级3例，Ⅲ级1例，Ⅳ级1例。所有患者在手术前行脑血管造影获得平板DSA三维影像数据和MRI层厚2.0 mm三维断层影像数据，手术中将MRI与DSA三维影像数据通过Dicom接口输入神经导航系统进行融合，在神经导航引导下行显微直视手术切除、夹闭或电灼病灶，术后均复查DSA或320-CTA。结果 5例患者均手术成功切除病灶。术后4例患者恢复良好，无神经功能障碍；1例出现脑分裂综合征。结论 在脑深部血管微小病变手术中，使用MRI与DSA三维影像数据输入神经导航，能够精准找到脑深部微小血管病灶并看清楚病灶与周围脑结构的解剖关系，以最小手术损伤完整、彻底的切除脑深部血管微小病灶。

Neuronavigator-assisted microsurgery for cerebrovascular disease in deep brain regions using input of preoperative MRI and DSA three-dimensional images fusion data into neuronavigation system

Objective To explore the value of the input of preoperative MRI and DSA three-dimensional (3D) images fusion data into neuronavigation system to microsurgery for the cerebraovascular disease in deep brain regions. Methods The clinical data of 5 patients with cerebraovascular disease in deep brain regions, who underwent neuronavigator-assisted microsurgery by the input of the preoperative MRI and DSA 3D-images fusion data into the navigation system from August, 2013 to March 2015, were analyzed retrospectively. Of 5 patients with cerebraovascular disease, I suffered from Moyamoya disease associated with distal choroidal artery aneurysm, 2 from arteriovenous malformation associated with venous aneurysms, 1 from the second segment of anterior cerebral artery and pericallosal artery traumatic pseudoaneurysm and 1 from anterior cranial fossa dural arteriovenous fistula. The DSA and MRI were performed for 3D-images and their 3D-images fusion were performed before the microsurgery in all the patients. The DSA and MRI 3D-images fusion data were inputed into the neuronavigation system and fused each pther. The cerebrovascular lesions were resected or clipped by the neuronavigator-assisted microsurgery. Results The cerebrovacular lesions were successfully resected or clipped in all the patients. Of 5 patients, 4 were recovered well and had no neurological disorder, 1 had split brain syndrome. Conclusions The tiny cerevrovascular lesions and their boundaries in the deep brain regions may be found by MRI and DSA 3D-iamge fusion data combined with neuronavigation, the small cerebrovascular lesions may be totally removed under the circumstances of minimal operative side-injury.