MRI容量重建技术在颞上沟-侧脑室颞角手术入路选择中的应用

目的:通过测量经颞上沟-侧脑室颞角手术入路的相关数据，初步定位大脑背外侧面颞上沟进入侧脑室最短距离的点，寻找经颞上沟进入侧脑室颞角的最佳手术入路点。方法：选取120例成年人脑部MRI扫描标本，利用容量重建技术构建大脑三维立体模型，测得颞上沟的长度S1。沿垂直于颞叶长轴的方向以1.0 mm间距切割得到多个冠状切面，依次测量颞上沟到侧脑室颞角的距离并确定最短距离S2，同时测量颞上沟的深度S3，测量大脑颞上沟表面相对应的最短距离点到颞上沟前端起始部的距离S4，计算S4与S1的比值M，同时测量最短距离与正中矢状位方向之间的夹角α。所有样本进行双侧测量，对比两侧的测量结果。 结果：120例国人的S1左侧为（159.56±17.55）mm，右侧为（164.35±15.07）mm，左右两侧比较差异无统计学意义（P>0.05）；S2左侧为（8.18±0.96）mm，右侧为（7.81±0.90）mm，左右两侧比较差异无统计学意义（P>0.05）；S3左侧为（12.19±1.43）mm,右侧为（11.57±1.33）mm，左右两侧比较差异无统计学意义（P>0.05）；S4左侧为（100.88±16.09）mm，右侧为（104.15±14.49）mm,左右两侧比较差异无统计学意义（P>0.05）；M左侧为（0.63±0.07），右侧为（0.63±0.06），左右两侧比较差异无统计学意义（P>0.05）；α左侧为（55.80±3.64）°，右侧为（56.46±4.17）°，左右两侧比较差异无统计学意义（P>0.05）。结论：颞上沟前端3/5处可能为理想的手术入路点，由该点进入侧脑室颞角距离最短，提示实施颞上沟-侧脑室颞角手术时该入路可减少对脑组织损伤。

Application of MRI volume rendering in surgical approach by superior temporal sulcus-temporal horn of lateral ventricle

Objective To acquire some related data of surgical approach through brain superior temporal sulcus to temporal horn of lateral ventricle by MRI volume rendering,and to orientate the point of superior temporal sulcus on the lateral surface which is closest to temporal horn of lateral ventricle,and to find out the best entrance point of surgical approach through superior temporal sulcus to temporal horn of lateral ventricle.Methods 120 adult cases of MRI scanning specimens were chosen for measurement.MRI volume rendering technology was used to rebuild the brain 3D model for the measurement of the full length of superior temporal sulcus S1.Then cutting along the prependicular to the direction of the long axis of the temporal lobe with 1.0mm spacings,the coronal sections were obtained,and the distance from superior temporal sulcus to temporal horn of lateral ventricle was ordinally measured and the shortest distance S2 was made sure.And the depth of superior temporal sulcus S3 was detected.The corresponding point on the surface of the brain at superior temporal sulcus according to the point leading the shortest distance S4 was determined.The ratio of S4 to S1 M was calculated.The angle between the shortest distance and median sagittal plane asαwas determined.All the samples were measured on both sides of the brain and all the data were compared.Results The S1 of the 120 cases was(159.56±17.55)mm on the left and(164.35±15.07)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S2was(8.18±0.96)mm on the left and(7.81±0.90)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S3 was(12.19±1.43)mm on the left and(11.57±1.33)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S4 was(100.88±16.09)mm on the left and(104.15±14.49)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the M was(0.63 ±0.07)on the left and(0.63 ±0.06)on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);theαwas(55.80±3.64)°on the left and(56.46±4.17)°on the right,there was no statistical difference between two cerebral hemispheres(P>0.05).Conclusion The point at the front side 3/5of superior temporal sulcus may be the ideal surgical approach entrance point.The distance from the point to temporal horn of lateral ventricle is shortest.It indicates that the approach can reduce the damage of brain tissue.