3D Slicer多模态影像融合技术在脑膜瘤手术中的应用

目的 探讨3D Slicer多模态影像融合技术在颅底脑膜瘤或巨大脑膜瘤手术治疗中的应用效果。方法 回顾性分析2016年6月至2019年5月应用3D Slicer多模态影像融合技术辅助手术治疗的12例颅底脑膜瘤或巨大脑膜瘤的临床资料。术前完善头颅CT、MRI、TOF-MRA、DTI序列检查，将得到的DICOM格式的影像学数据，应用3D Slicer软件进行处理，对肿瘤、相邻颅骨、重要动脉、颅神经、静脉、静脉窦、锥体束进行多模态融合和三维重建，明确肿瘤与周围结构的关系，通过3D虚拟可视化图像，模拟手术入路，精准术前规划，辅助进行手术治疗。结果 12例中，肿瘤全切除10例（83.33%，10/12），次全切除2例。无手术死亡病例，无术区血肿及颅神经损伤。术后出现对侧肢体肌力下降或原有偏瘫症状加重2例，经治疗后肌力恢复正常。12例术后随访6个月，未见肿瘤复发或增大。结论 对于颅底脑膜瘤或巨大脑膜瘤的手术治疗，3D Slicer多模态影像融合技术可以帮助制定详尽的术前规划，减少手术并发症，提高肿瘤的全切除率。

Application of 3D Slicer multimodal image fusion technique in surgery for patients with skull base meningioma or giant meningioma

Objective To explore the application value of 3D Slicer multimodal image fusion technique in the surgical treatment of patients with skull base meningioma or giant meningioma. Methods The clinical data of 12 patients with skull base meningioma or giant meningioma who underwent surgery assisted by 3D Slicer multi-modal image fusion technique from June 2016 to May 2019 were retrospectively analyzed. Examinations of head CT, MRI, TOF-MRA, DTI sequence were performed before the surgery, and 3D Slicer software was used to process the acquired imaging data in DICOM format to clarify the relationship between the tumor and the surrounding tissues inclusing adjacent skulls, important arteries, cranial nerves, veins, venous sinuses, and pyramidal tract. The surgical approach was simulated and the precise preoperative planning was made to assist the surgical treatment by the 3D virtual visualization image. Results Total tumor resection was achieved in 10 of 12 patients (83.33%, 10/12) and subtotal in 2. There were no operative deaths, and no hematomas and cranial nerve injuries in the operation region. After the operation, the contralateral limb muscle strength decreased or the original symptoms of hemiplegia were aggravated in 2 patients, and the muscle strength returned to normal after treatment. The follow up (6 months) reseults showed no tumor recurrence or enlargement. Conclusions For the surgical treatment of patients with skull base meningioma or giant meningioma, 3D Slicer multimodal image fusion technique can help to make detailed preoperative planning, reduce surgical complications, and increase the total tumor resection rate.