[1]崔昊,王奎重,王小刚,等.3D Slicer三维重建技术辅助手术治疗枕骨大孔区硬脑膜动静脉瘘：附1例报道并文献复习[J].中国临床神经外科杂志,2024,29(02):84-87.[doi:10.13798/j.issn.1009-153X.2024.02.005]
　CUI Hao,WANG Kui-zhong,WANG Xiao-gang,et al.Surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for dural arteriovenous fistula in the foramen magnum: a case report and literature review[J].,2024,29(02):84-87.[doi:10.13798/j.issn.1009-153X.2024.02.005]
点击复制

3D Slicer三维重建技术辅助手术治疗枕骨大孔区硬脑膜动静脉瘘：附1例报道并文献复习()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年02期
页码:
84-87
栏目:
论著
出版日期:
2024-02-28

文章信息/Info

Title:
Surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for dural arteriovenous fistula in the foramen magnum: a case report and literature review
文章编号:
1009-153X（2024）02-0084-04
作者:
崔昊; 王奎重; 王小刚; 徐广振; 王伯栋; 朱伟杰
261053山东潍坊，潍坊医学院临床医学院（崔昊）；250031济南，联勤保障部队第九六〇医院神经外科（崔昊、王奎重、王小刚、徐广振、王伯栋、朱伟杰）
Author(s):
CUI Hao1; 2;  WANG Kui-zhong2;  WANG Xiao-gang2;  XU Guang-zhen2;  WANG Bo-dong2;  ZHU Wei-jie2
1. Weifang Medical College, Weifang 261053, China; 2. Department of Neurosurgery, the 960th Hospital of Joint Logistic Support Force, Jinan 250031, China
关键词:
硬脑膜动静脉瘘; 枕骨大孔区; 手术治疗; 3D Slicer三维重建技术
Keywords:
Dural arteriovenous fistula;  Foramen magnum region;  Surgery;  3D Slicer software;  3D reconstruction technology
分类号:
R 743; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2024.02.005
文献标志码:
A
摘要:
目的 探讨枕骨大孔区硬脑膜动静脉瘘（DAVF）的影像学特征以及3D Slicer三维重建技术辅助手术治疗的疗效。方法 回顾性分析2021年6月收治的1例枕骨大孔区DAVF的临床资料，并结合相关文献进行分析。结果 50岁男性，因双下肢麻木及疼痛不适1个月入院。脊柱MRI显示延髓至颈5水平颈髓异常信号。双侧颈内动脉、双侧颈外动脉、右侧椎动脉造影未发现异常，左侧椎动脉造影显示枕骨大孔区DAVF，由脑膜后动脉多个分支供血，经小脑表面及数支硬脑膜迂曲扩张的皮质静脉引流汇入左侧横窦、岩上窦及基底窦，并可见迂曲的硬脊膜前、后静脉参与瘘口血液引流；左侧小脑后下动脉（PICA）靠近瘘口部位走行且迂曲。3D Slicer三维重建影像清晰显示DAVF的位置、供血动脉和引流静脉，多模态重建显示瘘口位于枕部后正中枕骨大孔上区域并靠近硬脑膜。采取枕颈部后正中入路手术，术中吲哚菁绿荧光造影确认DAVF消失。术后3个月，双下肢麻木及疼痛感均有减轻；复查MRI显示脑干和脊髓水肿消失，DSA显示DAVF完全闭塞。结论 枕骨大孔区DAVF手术治疗可以显著改善病人预后，应用3D Slicer三维重建技术对DAVF进行精准定位能够在很大程度上节省手术时间并提高手术质量。
Abstract:
Objective To investigate the imaging features of patients with dural arteriovenous fistula (DAVF) in the foramen magnum region and the efficacy of surgical treatment assisted by three-dimensional image reconstruction based on 3D Slicer software for such patients. Methods The clinical data of a patient with DAVF in the foramen magnum region admitted in June 2021 were retrospectively analyzed, and the relevant literatures were reviewed. Results A 50-year-old man was admitted to hospital due to numbness and pain in the lower limbs for 1 month. Spinal MRI showed abnormal signals of cervical spinal cord from medulla oblongata to the C5 spinal cord. Angiographies via bilateral internal carotid arteries, bilateral external carotid arteries, and the right vertebral artery showed no abnormalities, while angiography via the left vertebral artery showed DAVF in the foramen magnum region, which was supplied by multiple branches of the posterior meningeal artery, and drained into the left transverse sinus, suprapetrosal sinus, and basilar sinus through the severely tortuous dilated cortical veins of the dura mater. The tortuous anterior and posterior dural veins were involved in the blood drainage of the fistula. The left posterior inferior cerebellar artery (PICA) was running and tortuously near to the fistula. The three-dimensional reconstructed images using 3D Slicer software clearly showed the location of DAVF, the feeding arteries and draining veins, and multimodal reconstructed images showed that the fistula was located in the posterior median region of the occipital foramen magnum and close to the dura mater. The patient underwent microsurgery through posterior median approach, and intraoperative indocyanine green fluorescence angiography showed the disappearance of DAVF. Three months after operation, the numbness and pain in the lower limbs were relieved; reexamination of MRI showed that the edema of brainstem and spinal cord disappeared, and DSA showed complete occlusion of DAVF. Conclusions Surgical treatment of DAVF in the foramen magnum can significantly improve the prognosis of patients. The application of 3D Slicer three-dimensional reconstruction technology to accurately locate DAVF can greatly reduce the operation time and improve the quality of operation.

参考文献/References:

[1]BAHARVAHDAT H, OOI YC, KIM WJ, et al. Updates in the management of cranial dural arteriovenous fistula [J]. Stroke Vasc Neurol, 2019, 5(1): 50-58.
[2]ZHAO J, XU F, REN J, et al. Dural arteriovenous fistulas at the craniocervical junction: a systematic review [J]. J Neurointervent Surg, 2016, 8(6): 648-653.
[3]CHANG HX, SHEN YQ, LI Z, et al. Hybrid operation for patients with dural arteriovenous fistula (report of 10 ceses) [J]. Chin J Clin Neurosurg, 2021, 26(4): 508-511.
常晗晓，沈榆棋，李　征，等. 复合手术在硬脑膜动静脉瘘治疗中的应用 [J]. 中国临床神经外科杂志，2021，26（7）：508-511.
[4]LLáCER JL, SUAY G, PIQUER J, et al. Dural arteriovenous fistula at the foramen magnum: report of a case and clinical-anatomical review [J]. Neurocirugia, 2016, 27(4): 199-203.
[5]WANG JY, MOLENDA J, BYDON A, et al. Natural history and treatment of craniocervical junction dural arteriovenous fistulas [J]. J Clin Neurosci, 2015, 22(11): 1701-1707.
[6]RUTKOWSKI MJ, JIAN B, LAWTON MT. Surgical management of cerebral dural arteriovenous fistulae [J]. Handbook Clin Neurol, 2017, 143: 107-116.
[7]GADOT R, GOPAKUMAR S, WAGNER K, et al. Foramen magnum dural arteriovenous fistula presenting with thoracic myelopathy: technical case report with 2-dimensional operative video [J]. Oper Neurosurg (Hagerstown), 2021, 21(1): E55-E59.
[8]LI HH, LI J, YOU HC, et al. Diagnosis and treatment of dural arteri-ovenous fistula draining to the diploic vein presenting with intra-cerebral hemorrhage: a case report and literature review [J]. Chin J Clin Neurosurg, 2021, 26(4): 529-530.
李欢欢，李　俊，游慧超，等. 与板障静脉沟通的硬脑膜动静脉瘘并发颅内出血1例报道及文献复习[J]. 中国临床神经外科杂志，2021，26（7）：529-530.
[9]KIM NH, CHO KT, SEO HS. Myelopathy due to intracranial dural arteriovenous fistula: a potential diagnostic pitfall: case report [J]. J Neurosurg, 2011, 114(3): 830-833.
[10] LEE SK, HETTS SW, HALBACH V, et al. Standard and guidelines: intracranial dural arteriovenous shunts [J]. J Neurointervent Surg, 2017, 9(5): 516-523.
[11] VAN DIJK JMC, TERBRUGGE KG, WILLINSKY RA, et al. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux [J]. Stroke, 2002, 33(5): 1233-1236.
[12] KAKARLA UK, DESHMUKH VR, ZABRAMSKI JM, et al. Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications [J]. Neurosurgery, 2007, 61(3): 447-459.
[13] ATTEYA MM. Frameless stereotaxy: it is all about precision [J]. Child's Nervous System, 2020, 36: 179-187.
[14] ZHOU L, WANG W, LI Z, et al. Clinical application of 3D-Slicer+ 3D printing guide combined with transcranial neuroendoscopic in minimally invasive neurosurgery [J]. Sci Rep, 2022, 12(1): 20421.

相似文献/References:

[1]张小征　莫雪红　杨　铭　李　俊　潘　力　陈　刚.彩色多普勒超声检测在硬脑膜动静脉瘘诊断中的应用[J].中国临床神经外科杂志,2017,(03):135.[doi:10.13798/j.issn.1009-153X.2017.03.002]
　ZHANG Xiao-zheng,MO Xue-hong,YANG Ming,et al.Application of transcranial color Doppler ultrasonography to diagnosis of dural arteriovenous fistulas[J].,2017,(02):135.[doi:10.13798/j.issn.1009-153X.2017.03.002]
[2]边　远　汤树洪　谭　衍　郑惠娜　梁　敏　冼克聪.Onyx胶联合弹簧圈治疗海绵窦区硬脑膜动静脉瘘[J].中国临床神经外科杂志,2018,(01):43.[doi:10.13798/j.issn.1009-153X.2018.01.017]
[3]尧小龙　丁　卫　岳鹏杰　胡　威　赵　恺　陈劲草　张华楸.颅前窝底硬脑膜动静脉瘘9例治疗分析[J].中国临床神经外科杂志,2018,(03):186.[doi:10.13798/j.issn.1009-153X.2018.03.015]
[4]董安石　廖旭兴　钟伟健　段成斌　刘鑫鑫　邓其峻　王　辉.血管内栓塞治疗侧窦区硬脑膜动静脉瘘（附10例报道）[J].中国临床神经外科杂志,2018,(12):782.[doi:10.13798/j.issn.1009-153X.2018.12.005]
　DONG An-shi,LIAO Xu-xing,ZHONG Wei-jian,et al.Endovascular treatment of dural arteriovenous fistulas in the lateral sinus regions[J].,2018,(02):782.[doi:10.13798/j.issn.1009-153X.2018.12.005]
[5]马廉亭,谢天浩,徐召溪.脑动静脉畸形、硬脑膜动静脉瘘与软脑膜动静脉瘘的鉴别[J].中国临床神经外科杂志,2019,(06):321.[doi:10.13798/j.issn.1009-153X.2019.06.001]
[6]王　涛　许　川　徐国政　向伟楚　祝友红　黄　成.伽玛刀治疗硬脑膜动静脉瘘的疗效观察[J].中国临床神经外科杂志,2019,(11):651.[doi:10.13798/j.issn.1009-153X.2019.11.004]
　WANG Tao,XU Chuan,XU Guo-zheng,et al.Curative effect of gamma knife on dural arteriovenous fistulas (report of 26 cases)[J].,2019,(02):651.[doi:10.13798/j.issn.1009-153X.2019.11.004]
[7]曾　实　 杨东虹　杨华江　徐伦山　易　良.眼眶内动静脉瘘2例[J].中国临床神经外科杂志,2020,(01):57.[doi:10.13798/j.issn.1009-153X.2020.01.021]
[8]叶铨秋　池锐彬.利用颈静脉血氧饱和度早期识别硬脑膜动静脉瘘1例[J].中国临床神经外科杂志,2020,(12):896.[doi:10.13798/j.issn.1009-153X.2020.12.029]
[9]常晗晓　沈榆棋　李　征　林　超　陈　骅　路　华.复合手术在硬脑膜动静脉瘘治疗中的应用[J].中国临床神经外科杂志,2021,26(07):508.[doi:10.13798/j.issn.1009-153X.2021.07.004]
　CHANG Han-xiao,SHEN Yu-qi,LI Zheng,et al.Hybrid operation for patients with dural arteriovenous fistula (report of 10 ceses)[J].,2021,26(02):508.[doi:10.13798/j.issn.1009-153X.2021.07.004]
[10]李欢欢　李　俊　游慧超　陈迎春　林爱龙　盛柳青　尧小龙.与板障静脉沟通的硬脑膜动静脉瘘并发颅内出血1例报道及文献复习[J].中国临床神经外科杂志,2021,26(07):529.[doi:10.13798/j.issn.1009-153X.2021.07.011]
　LI Huan-huan LI Jun,YOU Hui-chao,CHEN Ying-chun,et al.Diagnosis and treatment of dural arteriovenous fistula draining to the diploic vein presenting with intracerebral hemorrhage: a case report and literature review[J].,2021,26(02):529.[doi:10.13798/j.issn.1009-153X.2021.07.011]

备注/Memo

备注/Memo:
（2023-06-04收稿，2023-10-20修回） 通信作者：朱伟杰，Email：zhuweijie66@163.com
更新日期/Last Update: 2024-02-28