摘要目的 探讨多模态影像融合技术在神经内镜经鼻入路治疗前颅底肿瘤手术中的临床应用价值.方法 回顾性分析2016年1月至2017年6月于上海交通大学附属第一人民医院神经外科接受神经内镜经鼻手术治疗的9例前颅底肿瘤患者的临床资料.术前将患者的头颅CT、MRI以及CT血管成像(CTA)图像进行融合,根据影像融合结果行术中神经导航辅助手术切除肿瘤.分析多模态影像融合技术对前颅底病变及其毗邻解剖结构的显示效果.结果 术中多模态融合影像可清晰显示前颅底肿瘤病变及其毗邻的神经组织、血管、骨性结构、蝶窦以及气房分隔.9例患者均顺利完成手术,其中6例达到肿瘤全切除,3例达次全切除.术后所有患者均无迟发性出血、颅内感染、脑脊液鼻漏发生.结论 在神经内镜经鼻切除前颅底肿瘤手术中,应用多模态影像融合技术结合术中神经导航可清晰显示肿瘤及其毗邻的重要结构,有助于提高手术的准确性、安全性、有效性.

abstractsObjective To explore the value of muhimodal image fusion technique in neuroendoscopic endonasal treatment of anterior skull base tumors.Methods The clinical data of 9 patients with anterior skull base tumors who underwent endoscopic surgery at Department of Neurosurgery,Shanghai General Hospital,Shanghai Jiao Tong University from January 2016 to June 2017 were retrospectively analyzed.CT,MRI,and CT angiography (CTA) images of the patient's skull were fused before surgery,and intraoperative neuronavigation assisted surgical removal of the tumor was performed based on the results of the image fusion.This paper analyzed the effects of multimodal image fusion technology on demonstration of anterior skull base lesions and adjacent anatomical structures.Results During operation,multimodal image fusion clearly revealed the anterior skull base tumors together with adjacent neural tissues,blood vessels,bone structures,sphenoid sinus and septations.All 9 patients underwent successful operation.Among them,gross total resection of tumor was achieved in 6 cases and subtotal resection in 3 cases.No serious complications such as delayed hemorrhage,brain infection,and cerebrospinal fluid rhinorrhea occurred postoperatively.Conclusions In neuroendoscopic transnasal resection of the anterior skull base tumor,the application of multimodal image fusion technology combined with intraoperative neuronavigation can clearly show the location of tumor and its adjacent important structures,which helps improve the accuracy,safety,and effectiveness of the operation.