| Background and Objective In the field of neurosurgery,lesions involving functional areas of the brain may lead to sensory,motor,speech and other impairments,and reduce the quality of life of patients.How to remove the lesion to the maximum extent and at the same time preserve the neurological function to the maximum extent is a great challenge for neurosurgeons,and it is also the goal that neurosurgeons pursue in the process of diagnosis and treatment.Complications such as limb motor dysfunction,sensory dysfunction and speech disorders are common in the surgical treatment of lesions in brain functional areas.These complications seriously affect patients’ quality of life.Among them,the most common causes of limb movement disorders are: lesion and its surrounding edema involved in the motor cortex and pyramidal tract;Language disorders are related to the arcuate fibers of the dominant hemisphere and the inferior frontal occipital tract.It has long been a difficult and hot topic in the field of neurosurgery that how to completely remove lesions without causing dysfunction in brain functional areas.Diffusion Tensor Imaging(DTI)is a non-invasive Imaging examination method that can effectively observe and track the white matter fiberbundles in the brain.It is mainly used for the observation and tracking of the white matter fiber bundles in the brain,the study of brain function,and the preoperative planning and postoperative evaluation of neurosurgery.With the development of computer aided tools in neurosurgery,3D reconstruction of DTI data and traditional imaging data,such as MRI,MRA,MRV,CT,etc.,to achieve multimodal image fusion,has become a popular method to guide the operation of brain functional areas,and has become a popular method to optimize the operation planning of brain functional areas.In this study,Diffusion Tensor Tracking(DTT)is realized by 3D reconstruction of DTI data using 3D-Slicer software.At the same time,using 3D-Slicer software,the conventional imaging data were used for the three-dimensional reconstruction of the lesion and its surrounding blood vessels,brain tissue and other structures.The above results were fused into the software to realize the visualization of the relationship between the white matter fiber bundles and the lesion.To explore the application of this method in the operation of intracranial tumors with cerebral functional lesions,mainly involving the destruction or compression of cerebral white matter fiber bundles,so as to plan the surgical approach preoperatively and achieve the maximum degree of tumor removal on the basis of the maximum protection of cerebral function during the operation.Materials and methods A total of 80 cases of tumors involving cerebral functional areas and cerebral white matter fibers were collected from the Neurosurgery Department of the Second Affiliated Hospital of Zhengzhou University from September 2018 to January 2021,including 55 gliomas and 25 meningiomas.The functional areas involved were all anterior central gyrus and its related corticospinal tract.They were randomly divided into experimental group and control group.Experimental group 42 cases: the 3D-Slicer DTI fiber bundles tracking software,at the same time using conventional image data of lesions,the 3D reconstruction of blood vessels,such as brain tissue structure,judging by the tumor invasion after fusion of white matter fiber bundle displacement and damage,at the same time shows that the tumor and arteriovenous anatomic relationship of individualized design and simulation approaches and guide surgery.The control group(n = 38)was treated with conventional 2D image data to locate the lesion and guide the operation.Patients in both groups were treated with neuronavigation assisted lesion resection during operation.Retrospective experimental analysis was conducted to record the age,gender,lesion side type and tumor pathological classification of the experimental group and the control group for statistical analysis,and the balance was good without statistical significance(P > 0.05).Two weeks after surgery: Functional recovery of muscle strength assessment and total tumor imaging resection rate were assessed.The Karnofsky Prognosis Scale(KPS)was used to assess the outcome of the patients at 1 month postoperatively.Results Among the 42 patients in the experimental group,36 cases(85.7%)were completely excised by tumor imaging,and 6 cases(14.3%)were subtotal excised.The motor dysfunction was improved in 33 cases(78.5%)2 weeks after surgery.There was no improvement in 5 cases.Four patients had normal preoperative limb movement and normal muscle strength assessment.Among them,3 patients had transient limb dysfunction,which recovered on the 8th to 10 th day after surgery.No case of limb movement disorder was aggravated.The mean KPS score one month after operation was(93.33±9.79),and the rate of good prognosis was(85.7%).Among the 38 patients in the control group,25 cases were completely resected(65.8%)and 13 cases were subcompletely resected(34.2%).Limb motor dysfunction improved in 22 cases(57.9%),and muscle strength decreased in 1 case.The mean KPS score one month after operation was(79.21±13.62),and the rate of good prognosis was(52.6%).There was statistically significant difference in the rate of neurological improvement between the experimental group and the control group(P < 0.05),and there was statistically significant difference in the rate of imaging resection(P < 0.05).Conclusion Application of 3D-Slicer software of the DTI data line tracking of fiber bundles,to other MRI,CT data sorting,registration and modeling,the lesions and peripheral nerve fiber bundle,blood vessels,brain tissue,such as fusion model structure,realize the transparency of the surgical approach,simulation of surgical approach,helps to individualized design optimal operation plan,the curative effect of the surgery. |
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