Clinical Application Of Multimodal Neuro-navigation In Midline Meningiomas Surgery

Objective:To introduce the clinical application of multimodal neuro-navigation in the midline meningiomas surgery.Patients and methods:This study included a total of 60 patients who had midline meningiomas resected by multimodal neuro-navigation between October 2015 and January 2019 in the First Affiliated Hospital of SooChow University,there were 15 male and 45 female,the mean age of patients was 57.4±9.5 years(range 24 to 79).Major clinical symptoms included dizziness and headache,olfactory disorder,vision and visual field disorders,other cranial nerve disorders movement disturbance,visual disturbance,seizures,and mental changes.All patients underwent preoperative computed tomography(CT)and magnetic resonance imaging(MRI).The maximum diameter of tumor was 1.5cm-6.9cm,<3cm in 24 cases,3?5cm in 22 cases,>5cm in 14 cases,the tumor was located in the parasagittal in 10 patients,in 6 patients the tumor was located in the parafalcine region,in the convex functional area in 18 patients,in 5 patients the tumor was located in the olfactory groove,in 5 patients the tumor was located in the sphenoid ridge,in 4 patients the tumor was located in the parasellar,in 6 patients the tumor was located in the petroclival region,in 4 patients the tumor was located in the cerebellopontine angle region,and in 1 patient the tumor was located in the intraventricular region.Before the operation,iPlan Cranial 3.0 software was used to obtain the three-dimensional fusion of specific images by adjusting different thresholds,data were fused automatically with the normalized mutual information method,the data combined with MR1,MRA,MRV,DTI and thin-slice CT.Consequently,the appropriate route for resection of the tumor was designed according to the 3-D images.The Brain-Lab navigation system was used to mark and localizate midline meningiomas accurately,especially for tumor with smaller diameter and deeper location.The enhanced MRI was performed within 72 hours to determine the extent of resection and follow up the recovery of the patients.The application value of multimodal neuro-navigation for the resection of mdline meningiomas was analyzed.Results:No significant differences between the tumor and surrounding structures were found intraoperatively and preoperatively.According to Simpson classification,Simpson grade ? resection was achieved in 50 patients,grade ? resection was achieved in 3 patients,grade ? resection was achieved in 3 patients,grade ? resection was achieved in 4 patients.53 patients had no new neurological deficits after operation,in addition,no complications such as massive hemorrhage,cerebral infarction,or dysfunction were observed after operation.Oculomotor nerve and abducent nerve injuries occurred in 4 cases of petroclival meningioma after operation,1 case of convex meningioma in functional area had acute epidural hematoma,1 case of right ventricular meningioma had hydrocephalus after operation,and 1 case of meningioma in anterior cranial fossa had cerebrospinal fluid leakage after operation.Conclusion:1.Multimodal neuro-navigation can provide accurate information about the locations of tumor,draining veins and the precise relationship between tumor and surrounding structures;2.For meningioma with smaller diameter and deeper location,multimodal neuro-navigation can localizate midline meningiomas accurately;3.The relationship between tumors and arteries,veins,white matter fiber bundles can be displayed preoperatively based on the basis of 3D fusion images,and formulate preoperative appropriate surgical approaches,it can maximize the removal of tumors and minimize neurological impairment in patients.It has great application value in clinical practice.