3D-Slicer软件在神经内镜经鼻蝶入路垂体腺瘤手术中的应用

Clinical application of 3D-Slicer software in endoscopic transsphenoidal surgery for pituitary adenoma

摘要:

目的 探讨3D-Slicer软件辅助神经内镜经鼻蝶入路垂体腺瘤手术的疗效与价值。方法 28例垂体腺瘤患者行头颅CT和头颅MRI检查，将影像数据输入3D-Slicer软件，对蝶窦、鞍区骨性结构、垂体腺瘤及颈内动脉、视神经结构进行三维重建，并行术前规划，判断神经血管和肿瘤的空间关系，模拟磨除鞍底的过程，将重建图像与术中图像进行比较，评价两者吻合程度，记录术后并发症和疗效。结果 所有患者的三维重建图像中，蝶窦、鞍区骨性结构、垂体腺瘤及神经血管均可清晰显示，与术中内镜下实际图像高度匹配，能准确识别重要结构，并规划出鞍底骨窗的合适范围。所有患者手术过程顺利，术后均未发生严重并发症。结论 3D-Slicer软件运用于神经内镜下经鼻蝶入路垂体腺瘤手术，有助于术前明确显示蝶窦、蝶鞍、肿瘤与神经血管的空间关系，可帮助提高手术安全性与手术效率。

Abstract:

Objective To evaluate the practical efficacy and value of 3D-Slicer software assisted endoscopic transsphenoidal surgery for pituitary adenoma.Methods There were 28 patients with pituitary adenoma included. Their image data were input into 3D-Slicer software. The three-dimensional reconstruction of sphenoid sinus, sellar region, pituitary adenoma, internal carotid artery and optic nerve were performed. Preoperative planning was performed to determine the spatial relationship among these structures. The process of removing sellar bottom was simulated. The reconstructed images were compared with intraoperative images to evaluate the degree of anastomosis and the postoperative complications.Results The three-dimensional reconstructed images of all patients showed clear visualization of the sphenoid sinuses, the bony structures of the sellar region, the pituitary adenoma, and the neurovasculature, which were well matched with the actual intraoperative endoscopic images and could accurately identify the important structures and plan out the appropriate extent of the bone window of the sellar base. All surgical patients have successfully completed the procedur, and none developed severe comorbidities after surgery.Conclusion The application of 3D-Slicer software in transsphenoidal endoscopic surgery of pituitary adenoma is helpful to visualize the spatial relationship between sphenoid sinus, sellar region, tumor and blood vessels and nerves, and improve the safety and effectiveness of surgery.