Novel Application Of "3D DSA Based Neuronavigation" Technology In Extracranial-Intracranial Bypass Surgery

Ischemic cerebrovascular disease(ICVD)is a general term for a variety of ischemic cerebrovascular diseases.The etiology of ICVD is diverse and the pathological mechanism is complicated.However,there are three basic pathological processes involved in various etiologies:corresponding vascular wall lesions,changes in blood components and hemodynamics.The main diseases include:hypertensive,atherosclerosis and moyamoya disease.This article uses moyamoya disease as an example to explore the feasibility and validity of 3D DSA based neuronavigation technology in intracranial and extracranial bypass surgery.And to record the modified Rankin scale scores of each patient at different periods before and after surgery to determine the improvement of neural function.Objective To explore the feasibility and validity of 3D DSA based neuronavigation technology in intra cranial and extracranial bypass surgery.And to record the modified Rankin scale scores of each patient at different periods before and after surgery to determine the improvement of neural function.Methods Five patients who underwent bypass surgery in the department of neurosurgery of the central theater general hospital from August 201 8 to October 2019 were included.There were 3 males and 2 females,aged from 35 to 64 years,with an average age of 47±11.25 years.The course of disease was from 1 to 6 months,with an average of 2.5±2.1 months.The inclusion criteria were as follows:patients who were confirmed by digital subtraction angiography(DSA)to have cerebral hypoperfusion caused by moyamoya disease or moyamoya syndrome and intracranial bypass surgery after evaluation.Before and during the operation,the middle meningeal artery was recorded with the aid of 3D DSA based neuronavigation technology to avoid the injury of the artery w hen the bone flap was opened,and the number of cases successfully recorded and preserved was recorded.The distance from the pterional center to its parallel line and the intersection point of the middle meningeal artery was measured and recorded on the dual-volume images reconstructed by intraoperative and preoperative.respectively,and the accuracy was compared and analyzed.The modified Rankin Scale scores of each patient before surgery,1 week after surgery and 6 months after surgery were recorded to determine whether the postoperative neurological function of the patients had been improved.Results 4 patients used this method to trace the middle meningeal artery on the surface of the skull before milling the skull.4 patients use the navigation software Synergy Cranial to automatically generate the middle meningeal artery trajectory.The middle meningeal artery was not clearly developed on 1 patient.The Lasso tool on the navigation device was used to manually trace the middle meningeal artery to complete the operation.The middle meningeal artery was kept intact during the operation.The Wilcoxon signed rank test was performed on the preoperative mRS score of each patient and the score at 1 week after the operation.The preoperative mRS score of each patient was compared with the score 1 week after the operation,The p value was 0.157>0.05,there were no statistical significance of mRS score.The preoperative mRS score of each patient was compared with the score 6 months after the operation,and the p value was 0.046<0.05,showing a statistically significant difference.The neurological function of the patients undergoing intracranial bypass surgery assisted by 3D DSA navigation was improved after the operationConclusion The method of using the fusion image to locate the middle meningeal artery during bypass surgery is feasible.It can judge the position and location of the middle meningeal artery before and during the operation,thereby reducing the damage to the middle meningeal artery during each step of the operation.The opportunity is a technology worth promoting and applying.And for patients with moyamoya disease or moyamoya syndrome,bypass surgery under navigation assistance can effectively improve postoperative nerve function.