增强现实技术辅助神经内镜微创手术治疗高血压脑出血

摘要

目的 探讨增强现实技术在神经内镜微创手术治疗高血压脑出血(HICH)的临床应用价值.方法 分析20例增强现实技术辅助神经内镜精准手术治疗HICH的临床资料.术前手术穿刺部位和血肿侧颞部贴电极片,CT扫描并用3D-Slicer软件对头颅CT DICOM格式数据资料进行三维重建,模拟穿刺路径、测量穿刺深度、血肿体积.投影三维重建模型(包括电极片和血肿模型)与患者预贴电极片位置吻后,标记血肿体表投影、穿刺路径投影,术中激光指导穿刺方向,应用神经内镜微创清除血肿.结果 根据术前3D-Slicer软件重建结果 投影,结合激光定位,均成功穿刺血肿达目标位置,并在神经内镜辅助下顺利完成手术操作.本组病例手术时间18~85min,平均(32±3.5)min;术中失血5~15ml,平均(8±2.6)ml;术后CT复查提示血肿残留平均约(2.12±2.00)ml,血肿清除率达95.67%±4.07%;住院时间8~35d,平均(19.40±7.65)d;未发现颅内再出血及与手术相关并发症. 结论 增强现实技术结合激光定位可为HICH内镜微创手术提供精确的穿刺定位,提高手术成功率.%Objective To investigate the clinical value of augmented reality technique in endoscopic surgery for hypertensive intracerebral hemorrhage (HICH). Method The clinical data of 20 HICH cases undergoing endoscopic surgery assisted with augmented reality technique were analyzed retrospectively. Electrode pieces were attached to the temporal scalp of hematoma side and the patients were accepted CT scan. Before operation, The DICOM data of brain CT scan were reconstructed through 3D-Slicer software, and the puncture depth, hematoma volume were measured precisely. 3D-dimensional reconstruction model (including electrode pieces and hematoma model) were projected by the projector to match the pre-pasted electrode pieces, and hematoma surface projection and puncture path projection were marked. Intra-operative laser guidance was employed to accurately guarantee the puncture direction, and hematoma evacuation was performed via neuroendoscopy. Results All of the intracranial hematomas were precisely punctured to the target location and successfully evacuated with neuroendoscopy based on the reconstruction result of 3D-Slicer software and laser positioning. The mean surgical time was 32±3.5min, ranging from 18 to 855 min. The mean intra-operative blood loss was 8±2.6ml, ranging from 5 to 15ml. Postoperative CT reexamination demonstrated that average residual hematoma was about 2.12±2.00ml and the average hematoma evacuation rate was 95.67%±4.07%. The average hospital stay was 19.40±7.65d ranging from 8 to 35d. No patient experienced postoperative rebleeding and operation-correlated complications. Conclusion Augmented reality technique,combined with laser positioning, can provide precise puncture location positioning for hypertensive intracerebral hemorrhage and facilitate the success rate of operation.