Application Of Neuro-navigation Based On Multimodal Image Fusion In Skull Base Tumor Surgery

Background and ObjectiveSkull base tumors are a common disease faced by neurosurgeons.The reason for the difficulty in the operation of skull base tumor is that the tumor is located deep in the skull base and not easy to be exposed.Besides,the skull base bone is uneven and many vessels and nerves go through the skull base.Finally,the operation space is narrow,and the nerve dysfunction of postoperative is a common phenomenon.Because of extruding or eroding the surrounding tissue,Large skull base tumors are mostly resulting in the destruction of the normal anatomical structure.For small tumors,it is difficult to determine the appropriate surgical approach before surgery.Adequate preoperative examination should be done for patients with skull base tumors.However,the current medical equipment collects the information of tissues and organs at a certain level of the human body,which reflects two-dimensional digital tomography images.Therefore,clinicians need to read those images on the film repeatedly,and then conduct virtual construction in their mind based on their own professional knowledge and clinical experience.After understanding the tumor location and surrounding tissues,they would begin to simulate the surgical approach.But,this traditional model is not only susceptible to subjective factors,but also has low sensitivity and accuracy.With the development of medical imaging technology and computer technology,gradually appeared in the modal of image fusion based on neuro-navigation technology not only can be in the same image frame synchronization displays various information,better realize the complementary advantages between different imaging mode,and can also be under the guidance of neural navigation real-time,dynamic and comprehensive display the operation process,make the operation process of "digital",and further on the basis of ensure operation safety protection in patients with nerve function,further implement the concept of,"accurate neurosurgery".Objective:to use the neuro-navigation system based on multimodal image fusion to guide the craniotomy process of skull base tumor,so as to achieve the goal of"maximum resection of lesions,minimum brain functional damage and best postoperative recovery" of 3M.Materials and methodsClinical data of 50 patients with cranial base tumor who received craniotomy in neurosurgery department of our hospital from July 2016 to June 2019 were selected.All patients underwent cranial CT,cranial MRI,MRA and other imaging examinations before surgery,and were followed up for 3-6 months after surgery.The operation was divided into fusion group and conventional group according to whether the operation was guided by the neural navigation system based on multimodal image fusion.In the fusion group,27 patients underwent preoperative image fusion with 3D slicer,and the surgical approach was designed and combined with neuro-navigation for surgical treatment.In the conventional group,23 patients underwent preoperative surgical design and treatment based on two-dimensional imaging combined with craniocerebral model.The operative duration,intraoperative blood transfusion,total tumor resection rate,postoperative hospital stay and prognosis were compared between the two groups.ResultsThe average operation time of the fusion group was 291,6±25.7 min,and that of the conventional group was 349.9±120.3 min.The average operation time of the fusion group was significantly shorter than that of the conventional group (P=0.032 <0.05).The postoperative hospitalization time of the fusion group was 15.7±2.1d,and that of the fusion group was 17.6±3.3d.The postoperative hospitalization time of the fusion group was significantly shorter than that of the conventional group (P=0.03 <0.05).There were 21 cases of total resection (77.8%),6 cases of subtotal resection,15 cases of total resection (65.2%) and 8 cases of subtotal resection in the fusion group,with no statistically significant difference (P=0.324> 0.05).In the fusion group,6 patients (22.2%) received intraoperative blood transfusion,21 patients received intraoperative blood transfusion,10 patients (43.5%) received intraoperative blood transfusion,and 13 patients received intraoperative blood transfusion,with no statistically significant difference (P=0.108> 0.05).There were 3 cases (11.1%) of postoperative complications in the fusion group and 9 cases (39.1%) in the conventional group,with a significant difference between the two groups (P=0.021 <0.05).ConclusionsThe precision surgical design based on multimodal image fusion has certain guiding significance for the operation of skull base tumor,and has positive significance in reducing the operation duration,reducing the postoperative hospitalization time and reducing postoperative complications.