多影像融合技术在神经导航手术的临床应用

目的 探讨多影像融合技术在神经导航手术的临床应用价值。方法 2001年10月至2002年8月，48例神经导航手术采用了多影像融合技术，病灶涉及部位包括：大脑半球功能区32例，颅底12例，其他4例。其中，CT MRI-T1W影像融合9例；MRI-T1W FLAIR影像融合5例；MRI=T1W MRI-BOLD影像融合14例；MRI-T1W DTI影像融合13例；MRI-T1W fMRI-BOLD DTI影像融合5例；MRI-T1W FLAIR fMRI-BOLD DTI融合2例。结果 病灶全切38例(79．2％)，次全切除5例(10．4％)，大部或部分切除2例，活检l例。术后1个月随访优良率(Karnofsky预后评分，KPS=90～100)72．9％，死亡1例(2、l％)，2例(4．2％)发生严重手术致残(KPS=40)。结论 多影像融合技术应用于神经导航可以提供更多的影像信息，实现个体化、最优化的术前计划和术中应变。在精确定位肿瘤的同时，还可以界定其与不同性质的解剖、功能结构间毗邻关系，符合最小创伤功能神经外科的发展趋势。

Application of multi-image-merged techniques in neuronavigation surgery

Objective To evaluate the usefulness of multi-image-merged techniques in neuronavigation surgery of brain tumors.Methods Multi-image-merged neuronavigation surgery was undertaken in 48 patients, among whom eloquent areas were involved in 32 cases,skull base in 12 cases,and others in 4cases. There were 9 cases of CT+MRI-T 1W fusion, 5 cases of MRI-T 1W+FLAIR fusion, 14 cases of MRI-T 1W+fMRI-BOLD fusion, 13 cases of MRI-T 1W+DTI fusion, 5 cases of MRI-T 1W+fMRI-BOLD+DTI fusion, 2 cases of MRI-T 1W+FLAIR+fMRI-BOLD+DTI fusion. Results The lesions were completely resected in 38 cases (79.2%), subtotally resected in 5 cases (10.4%), partially resected in 2 cases, and biopsy in 1 case. One month after operation Karnofsky prognosis scale (KPS) demonstrated 90~100 in 35 cases (72.9%), and 1 case of death(2.1%). 2 patients(4.2%)suffered postoperative disability (KPS=40). Conclusions The multi-merged images in neuronavigation surgery can offer not only more detailed information about macroscopic structure and anatomy, but also spatial evaluation of various biophysical and biochemical processes in brain tissue. In addition, multi-image-merged neuronavigation should be determined for designing individual and optimal operative projection. Furthermore, to integrate different images into traditional neuronavigation images during surgery, was valuable in mapping topographical margins of lesion itself and characteristics of neighboring anatomic and functional structures. It was demonstrated to be a safe, efficient, reliable implement in minimal invasive neurosurgery.