The Application Of Multifusion Volumetric Imaging Navigation In Skull Base Surgery

Objective To research the utility of multifusion volumetric imaging technology combined with neural navigation in the treatment of neurosurgery complex lesions to design reasonable operation scheme and intraoperative navigation guidance, and to explore and evaluate the influence of the way in lesion resection approach, the scope and to protect the surrounding tissue.Method Selection in the general hospital of tianjin medical university for surgical treatment of21patients with intracranial tumor (meningioma, blood capillary tumour, schwannoma, glioma, craniopharyngioma, chordoma) using the multifusion volumetric imaging technology and nerve navigation, and the lesion site Includ jugular vein orifice area, the cavernous sinus, petroclival, Cerebellopontine angle、 parasella、temporal bone rock department、temporal pole. Using computer imaging, high field strength nuclear magnetic resonance technology, digital silhouette and positron emission computed tomography imaging for CT, CTA, Dyna-CT, MRI, MRA, FLAIR,3D-FSPGR, DTI and BOLD, PET-CT image data, through brainlabiplan process simulation system software reconstruction model of the lesion and surrounding tissue, to protocol a surgical approach and lesion resection range.One case of MRA+MRV+CTA+3D-FSPGR+FLAIR fusion, six cases of CT+MRA+MRV+CTA+3D-FSPGR+DSA fusion, five cases of CT+MRA+MRV+3D-FSPGR+DTI fusion, three cases of CT+3D-FSPGR+DTI+MRA fusion, five cases of DSA+CT+3D-FSPGR+MRA+DTI fusion,one case of PET-CT+CT+3D-FSPGR+DTI+BOLD+MRA+FLAIR fusion. And through the neural navigation positioning guidance in operation.Result Using multifusion volumetric imaging technology, we can construct21cases of skull base surgery preoperative model and clear display lesions、peripheral nerves、blood vessels and bone. Through the special image sequences we show lesions border, and can be completed simulation process from the bone window to lesion resection. Combining neural navigation technique, we can clearly identify the important organizational structure and guide the operation, such as optic nerve、 internal carotid artery、the anatomy of the skull base marks, etc.l case selects through the mouth surgical approach;8cases select Suboccipital retrosigmoid approach;3cases select pterion approach,;1case selects bottom of longitudinal crack surgical approach;1case selects frontotemporal surgical approach;2cases select presigmoid approach;1cases selects the occipital-cervical-beside condyle surgical approach;2cases select the lateral subtemporal intradural approach;1cases selects the Kauase approach;1cases selects the Dolenc approach.16cases total excision of the lesion,and because of the lesion and surrounding tissue or close function area,5cases partial resection. Postoperative patients recover well, and review images to show that the original surrounding tissue is good.Conclusion In neurosurgical diseases, the lesion of skull base with close ties to surrounding tissue or important functional areas, using multifusion volumetric imaging technology and navigation technology can clear structure the model of lesion, and integrate more image information, and protocol patients’individualized, reasonable Operation scheme and intraoperative emergency response plan. It can reduced the impact of subjective human factors which ever more dependent on the operation experience,and put forward the scientific and objective basis and testing way. Implementation of intraoperative localization guidance, not only conforms to the concept of minimally invasive, more helps performer determine the scope of the operation. And it is the assurance of quality of surgery. It can reduce the randomness of the procedure, and avoids the additional damage of unnecessary surgery step, and effectively protect the important organization, and promote the recovery of brain function. This method make a huge contribution in the construction of neurosurgery technology platform which integrated the concept of minimally invasive principle, and has played a huge role in improvement process. As well as the strict guidance education significance of clinical work cannot be neglected.