北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (4): 612-617.

• 论著 • 上一篇    下一篇

CT/MRI图像融合界面导航辅助三叉神经半月节穿刺的临床对照研究

王晶,翟新利△,贺洋,刘筱菁   

  1. (北京大学口腔医学院·口腔医院口腔颌面外科,北京100081)
  • 出版日期:2014-08-18 发布日期:2014-08-18

Controlled clinical study of trigeminal ganglion puncture guided by CT/MRI image fusion interface navigation

WANG Jing, ZHAI Xin-li△, HE Yang, LIU Xiao-jing   

  1. (Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China)
  • Online:2014-08-18 Published:2014-08-18

摘要: 目的:在CT/MRI图像配准和融合基础上,建立卵圆孔与半月神经节共存的三叉神经半月神经节射频温控热凝术导航手术界面,实现半月神经节与穿刺针关系的可视化,对比观察该方法的临床治疗效果。方法:将20例三叉神经痛患者的颅颌面区MRI和CT数据导入BrainLAB-iPlan导航设计系统,进行CT/MRI图像融合,建立卵圆孔与半月神经节共存的三维手术界面,设计以半月神经节为穿刺目标的个性化穿刺路径,行导航辅助半月神经节穿刺及温控射频热凝术。观察该组患者(融合导航组)治疗效果,并与既往采用CT引导下治疗的20例患者(CT组)进行对比。结果:融合导航组中,术前评估为疑难病例的3例患者治疗结果为未形成毁损或毁损范围不足,其余17例除2例因术中出血更改治疗方案外,均未出现上述结果。两组的临床治疗有效率均达到95%以上。结论:CT/MRI图像融合界面能够规划以半月节为目标的个性化穿刺路径,实现临床操作中以半月节为治疗靶位的目的。规划的路径能否到达半月神经节这一指标能够甄别出三叉神经半月节射频温控热凝术治疗中的疑难病例。

关键词: 三叉神经痛, 电凝术, 外科手术, 计算机辅助, 体层摄影术, X线计算机, 磁共振成像

Abstract: Objective:To build the radio-frequency thermocoagulation (RFT) interface under navigation including foramen ovale and trigeminal ganglion based on CT/MRI image fusion technology, to visualize the relationship between the trigeminal ganglion and the puncture needle, and to observe clinical effects of this method. Methods: CT and MRI data of 20 trigeminal neuralgia patients which were input into BrainLAB-iPlan navigation planning system, were aligned and merged, so that the 3-dimentional image fusion interface of CT and MRI for puncture was built. According to the image fusion interface, the pathways targeting the trigeminal ganglion were planned to assist trigeminal ganglion puncture and RFT. The treatment consequences were observed and compared with 20 patients under the RFT only with the direction of pre- and intra-operative CT. Results: In the group of CT/MRI image fusion cases, 3 cases had been predicted to be difficult because of unreachable ganglion through the foramen ovale pathway. The postoperative clinical examination proved that the ganglions of these 3 cases were only insufficiently damaged or undamaged. The other 17 cases proved better results, except 2 cases whose treatment was changed in operation. The valid rates for both image fusion navigation group and CT group were all above 95%. Conclusion:Navigation interface including both foramen ovale and trigeminal ganglion based on CT/MRI image fusion made visualization of the pathway targeting ganglion come true, which made the treatment more accurate and individual. Whether the pathway could reach the ganglion might distinguish the trouble cases from others.

Key words: Trigeminal neuralgia, Electrocoagulation, Surgery, computer-assisted, Tomography, X-ray computed, Magnetic resonance imaging

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