摘要
目的探讨术前基于弥散张量成像（DTI）重建面神经在听神经瘤患者手术中的应用价值。方法回顾性纳入2013年9月至2015年9月在天津医科大学总医院神经外科手术治疗的38例听神经瘤患者。术前行3．0T磁共振DTI扫描，利用3D—Slicer软件完成面神经纤维束示踪成像，并重建肿瘤三维影像；术中行电生理监测。评价手术的切除程度及面神经损伤情况。结果38例患者中，32例（84．2％）术前DTI重建面神经成像良好，能清晰地显示面神经与肿瘤三维空间关系，均与术中验证相吻合；6例（15．8％）面神经未能通过DTI技术重建显示。DTI显示面神经位于肿瘤的腹侧前下10例（31．3％），腹侧居中16例（50．0％），腹侧前上5例（15．6％），肿瘤下极1例（3．1％）。术中面神经解剖保留36例（94．7％）。术后7d，面神经功能House—Brackmann分级I级10例，Ⅱ级20例，Ⅲ级3例，Ⅳ一V级5例；面神经功能良好率为78．9％（30／38）。结论术前DTI下重建面神终技术可指导听神绎瘤患者术中肿瘤的切除．在一定程度上可以减少面神经的损伤。
Objective To investigate the clinical application value of preoperative facial nerve reconstruction by diffusion tensor imaging （DTI） in operations of acoustic neuroma. Methods We retrospectively collected 38 cases of patients who underwent operations of acoustic neuroma at Department of Neurosurgery, General Hospital of Tianjin Medical University from September 2013 to September 2015. Prior to operations, each patient underwent 3 T magnetic resonance DTI scanning. The facial nerve fiber tractography was made and the tumor was reconstructed with the software of 3D-Slice. Intraoperative electrophysiological monitoring was conducted to assess the degree of resection and facial nerve injury. Results Preoperative DTI reconstruction of the facial nerve was satisfactory in 32 （84.2%） out of 38 cases and clearly revealed the three-dimensional relationship between the facial nerve and the tumor, which was consistent with intraoperative verification. The facial nerve in 6 cases （ 15.8 % ）failed to be reconstructed by DTI tracer technique. DTI showed that the facial nerve was located at the ventral anterior inferior part in 10 （31.3%） cases, ventral central part in 16 （50.0%） cases, ventral anterior superior part in 5 （ 15.6% ） cases and lower part of the tumor in 1 （3.1% ） case. The facial nerve was anatomical preserved during operation in 36 （94.7%） cases. At 7 days post surgery, the facial nerve function was graded according to the House-Brackmann scale as 10 cases in grade I , 20 cases in grade 11 , 3 cases in grade m and 5 cases in grade 1V- V; and cases with good facial nerve function accounted for 78. 9% of all patients. Conclusion Preoperative reconstruction of the facial nerve by DTI could be used to guide resection of the acoustic neuroma and reduce the injury of facial nerve to a certain extent.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第5期475-478,共4页
Chinese Journal of Neurosurgery
基金
天津市自然科学基金（13JCZDJ30800）
关键词
神经瘤
听
面神经
弥散张量成像
纤维束示踪
Neuroma, acoustic
Facial nerve
Diffusion tensor imaging
Fiber tracking
作者简介
通信作者：岳树源，Email：yueshuyuan@163．com
