本文關鍵詞： 顱神經(jīng) 彌散張量成像 纖維束示蹤成像 前庭神經(jīng)鞘瘤　出處：《天津醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的顱神經(jīng)的三維成像在當今是一項具有重大意義的技術,它使得神經(jīng)外科醫(yī)師能夠在術前評估顱神經(jīng)受壓后的移位及形態(tài)學改變。在本研究中,作者嘗試應用彌散張量成像技術對健康受試者、顱底占位性病變患者進行相關顱神經(jīng)三維重建,驗證其可能性,并通過統(tǒng)計學分析探討此技術在前庭神經(jīng)鞘瘤手術中的應用價值。 方法在3.0T高場強核磁共振條件下,應用王維快速擾相梯度回波序列(3D fast spoiled gradient-echo sequence,3D-FSPGR),循環(huán)相位穩(wěn)態(tài)采集快速成像(Fast Imaging Empolying Steady State Acquisition, FIESTA),彌散張量成像(Diffusion tensor imaging, DTI)這三種不同的特殊掃描序列對所有受試者進行初步掃描。DTI資料整合入3D Slicer軟件來進行纖維束示蹤和重建,在軟件中結合3D-FSPGR或FIESTA圖像完成顱神經(jīng)走形和位置的定位。典型顱底占位性病變病例及前庭神經(jīng)鞘瘤病例,術前進行相關顱神經(jīng)示蹤重建及腫瘤體的三維重建,以此展示顱神經(jīng)與周圍病變之間的毗鄰、包裹、侵襲關系。術中結合顯微鏡下觀察和、或神經(jīng)電生理監(jiān)測記錄、核實的相關顱神經(jīng)及面神經(jīng)的位置。結果通過彌散張量成像技術,可確定健康受試者、以及典型顱底病變、前庭神經(jīng)鞘瘤患者的病變相關顱神經(jīng)的位置、走形,及形態(tài)改變。面神經(jīng)呈現(xiàn)為良好的三維重建像,尤其視交叉后部也成像清晰。三叉神經(jīng)(100%)出腦干最遠端可達半月神經(jīng)節(jié),近端達出腦干區(qū)。外展神經(jīng)(85%)腦池段成像良好,但Dorello管內(nèi)纖維束無法示蹤。面聽神經(jīng)(90%)成一束神經(jīng)纖維束復合體,腦池段至內(nèi)聽道內(nèi)重建良好。后組顱神經(jīng)纖維束較其他明顯纖細,迷走神經(jīng)、舌下神經(jīng)僅能示蹤重建出少量神經(jīng)纖維。10例顱底占位性病變病例中,相關顱神經(jīng)與占位性病變的三維空間關系通過腫瘤三維重建與顱神經(jīng)纖維示蹤得以完整呈現(xiàn),受累及的三叉神經(jīng)、外展神經(jīng)、面聽神經(jīng)等有不同程度的移位,其準確性經(jīng)過手術驗證無誤。21例前庭神經(jīng)鞘瘤病例中,19例患者的面神經(jīng)纖維束(19/21,90.5%),從腦干端到內(nèi)聽道的走形及解剖位置均可得到完好的展現(xiàn),面神經(jīng)橋小腦角段相對于腫瘤的位置,17例與術中顯微鏡下及神經(jīng)電生理監(jiān)測相符合(17/19,89.5%)。 結論依托與彌散張量成像技術及3D Slicer軟件,顱底相關的部分顱神經(jīng)三維重建在正�；蚴遣±隣顟B(tài)下是切實可行的。這項技術能夠在術前判斷顱底顱神經(jīng)與周邊病變的毗鄰、包裹、侵襲關系,尤其可完善前庭神經(jīng)鞘瘤手術術前計劃,指導術者術中精準操作,具有良好的臨床應用前景。
[Abstract]:Objective Three-dimensional imaging of cranial nerves is a significant technique, which enables neurosurgeons to evaluate the displacement and morphological changes of cranial nerves before operation. The authors attempted to use diffusive Zhang Liang imaging technique to reconstruct the cranial nerves in healthy subjects and patients with space-occupying lesions of the skull base. The application value of this technique in vestibular neurilemmoma surgery was discussed by statistical analysis. Methods under the condition of 3.0T high field nuclear magnetic resonance. The 3D fast spoiled gradient-echo sequence (3D-FSPGR) was applied to Wang Wei's fast disturbed phase gradient echo sequence. Fast Imaging Empolying Steady State requirements (Fiesta). Diffused tensor imaging with diffusion Zhang Liang. DTI) these three different special scanning sequences performed initial scanning. DTI data were integrated into 3D Slicer software for tracer and reconstruction of fiber bundles. 3D-FSPGR or FIESTA images were used to locate the shape and position of cranial nerve. The typical lesions of skull base and vestibular schwannoma were found. Preoperative cranial nerve tracer reconstruction and three-dimensional reconstruction of the tumor body were performed to show the relationship between the cranial nerve and the surrounding lesions. The location of the related cranial and facial nerves was verified by electrophysiological monitoring records. Results by means of diffusive Zhang Liang imaging technique, healthy subjects and typical skull base lesions could be identified. The location, shape, and morphology of the cranial nerve associated with the lesions in patients with vestibular schwannoma. The facial nerve presented a good three-dimensional reconstruction image. In particular, the posterior part of optic chiasma is also clear. The trigeminal nerve is 100) the farthest end of the brain stem can reach to the ganglion of the semilunar, the proximal end to the brain stem area and the abducent nerve 85) the cistern segment imaging is good. However, the fiber bundle in the Dorello tube could not be traced. The facial auditory nerve (90) formed a bundle of nerve fiber bundle complex, and the reconstruction from the cisternal segment to the internal auditory canal was good. The posterior cranial nerve fiber bundle was significantly thinner than the other ones. Vagus nerve, hypoglossal nerve can only be traced to reconstruct a small amount of nerve fibers. The three-dimensional relationship between cranial nerve and space-occupying lesion can be completely presented by three-dimensional reconstruction of tumor and tracer of cranial nerve fiber. The involved trigeminal nerve, abducent nerve, facial and acoustic nerve have different degrees of displacement. Its accuracy was proved correct by operation. 19 of 21 patients with vestibular schwannoma had facial nerve fiber bundle 19 / 21 / 90.5). The shape and anatomic position from the end of the brain stem to the internal auditory canal can be well displayed, and the position of the cerebellopontine angle relative to the tumor. 17 cases were in agreement with intraoperative microscope and electrophysiologic monitoring. Conclusion relying on and diffusing Zhang Liang imaging technology and 3D Slicer software. Three-dimensional reconstruction of cranial nerve associated with the skull base is feasible in normal or case status. This technique can determine the relationship between cranial nerve and peripheral lesions before operation. Especially, it can perfect the preoperative plan of vestibular neurilemmoma operation and guide the accurate operation during operation. It has a good clinical application prospect.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.41

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