To explore the clinical advantages of 3D-Slicer + 3D printing guide combined with transcranial neuroendoscopic in minimally invasive neurosurgery. By collecting the datum of patients who underwent craniotomy under 3D-Slicer + 3D printing guide plate positioning combined with transcranial neuroendoscopic in our hospital from October 2021 to February 2022, this paper introduces the accurate planning and positioning lesions of patients before operation and the minimally invasive operation of intraoperative neuroendoscopic and analyses clinical data such as lesion size and surgical bone window size. We collected the case datum of 16 patients who underwent craniocerebral surgery with 3D-Slicer + 3D printing guide combined with transcranial neuroendoscopic, including 5 males and 11 females, aged 46–76 years, including 6 brain tumors (3 meningiomas, 1 glioblastoma, 2 lung cancer brain metastases), 2 cavernous hemangioma, 7 hydrocephalus and 1 chronic subdural hematoma. The lesions of the 16 patients were located accurately before operation and the target areas were reached quickly during operation. Postoperative imaging datum confirmed that the lesions was removed fully, and the ventricular end of shunt tube was in good position. The technology of 3D-Slicer + 3D printing guide plate combined with transcranial neuroendoscopic is not difficult, which has many advantages such as inexpensive equipment, simple operation, easy learning, accurate positioning, and minimally invasive surgery. It is considered to be a practical technology that is feasible, reliable, convenient for diagnosis, preoperative planning and minimally invasive surgery. It is suitable for promotion in neurosurgery and other surgical departments of all medical institutions.
To explore the clinical advantages of 3D Slicer combined with Sina/MosoCam multimodal system in preoperative planning of brain lesions surgery. By collecting the data of brain lesions patients undergoing craniotomy under the preoperative positioning of 3D Slicer combined Sina/MosoCam multimodal system in the people's Hospital of Wuhan University from January 2021 to October 2021, the preoperative planning of patients was introduced, and the size of surgical bone window, operation time, preoperative and postoperative neurological dysfunction were counted. We collected the case data of 35 patients who were reconstructed by 3D Slicer and located by Sina/MosoCam projection. There were 14 cases of malignant tumors (7 cases of glioma, 2 cases of diffuse large B-cell lymphoma, 5 cases of metastatic cancer) and 21 cases of benign tumors (17 cases of meningioma, 1 case of central neurocytoma, 2 cases of cavernous hemangioma and 1 case of arachnoid cyst). All 35 patients were located accurately before operation, the lesions were found quickly during operation, and the postoperative imaging data confirmed that the lesions were removed completely, of which 28 cases (80%) had significantly improved neurological symptoms one month after operation. 3D Slicer combined with Sina/MosoCam multimodal system has many advantages, such as simple and easy to learn, convenient operation, accurate positioning and free. It is considered to be a new technology that is practical, reliable, convenient for diagnosis and preoperative planning. It is suitable for popularization and use in neurosurgery and other operating rooms of all medical institutions.
Objective To introduce a new “three-in-one technique” surgical approach of "stereotactic aspiration + neuroendoscopy + decompressive craniectomy” for spontaneous supratentorial intracerebral hemorrhage (SSICH) with tentorial herniation patients and to explore its preliminary application. Methods On our previous “two-in-one technique” operation, we further combined decompressive craniectomy to form a special surgical approach for SSICH with tentorial herniation patients. The operation included three steps: 1. Burr hole and aspirate partially clot to rapidly decrease intracranial pressure (ICP); 2. Remove the residual hematoma and stop the bleeding under neuroendoscope; 3. Decompressive craniectomy for further complete decompression. Clinical data of 17 patients with SSICH and cerebral hernia who underwent this approach in our department from January 2019 to February 2022 were collected, and time to access hematoma, hematoma evacuate rate and the outcome were analyzed. Results All procedures were successfully completed and the average access time to hematoma was 4.8 minutes in “three-in-one technique” group, which was much less than in craniotomy group (36.3 minutes) and neuroendoscopy group (9.9 minutes). Among the 17 patients, 3 died, 7 give up, 5 improved and 2 clinical cured. The poor prognosis (Death + Give up ) was 58.8% which was much better than traditional craniotomy group in previously published studies. Conclusions This “three-in-one technique” surgical approach combines the advantages of rapid decompression by stereotactic aspiration, full decompression and minimizing iatrogenic brain injury by neuroendoscope, complete decompression by decompressive craniectomy, which is a beneficial attempt for SSICH with tentorial herniation patients.
Spontaneous supratentorial intracerebral hemorrhage (SSICH) is an acute cerebrovascular disorder with high morbidity and mortality rates, Treatment of primary cerebral hemorrhage is controversial. However, postoperative rebleeding (or hematoma expansion) is a potential complication that can result in devastating progressive neurologic deterioration and high morbidity and mortality rates. It is also an inevitable and serious complication, which can result in progressive neurologic deterioration and death. The incidence of rebleeding 19.39% was found in our study and the results suggest that admission GCS score, irregular hematoma morphology on preoperative CT, poor postoperative blood pressure control, hematoma location, and surgical method were all risk factors of postoperative rebleeding. 3D Slicer-assisted neuroendoscopic surgery may be the most effective treatment for many patients with SSICH.
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