| Background and ObjectiveEpilepsy is a clinical syndrome in which brain neurons are highly synchronized and abnormally discharged due to complex causes.It has the characteristics of paroxysmal,transient and repetitive characteristics.Repeated seizures often lead to cognitive impairment of patients and impose a huge burden on the patients’ families and society.Glioma is the most common primary brain tumor,and epileptic seizure is one of its common clinical symptoms.Glioma-related epilepsy（GRE）is symptomatic epilepsy secondary to glioma,which is closely related to tumor development and has the characteristic of drug resistance.The coexistence of two serious diseases,tumor and epilepsy,further aggravates the brain tissue damage of gliomas with epilepsy,resulting in a great negative impact on the quality of life of these patients.As the core and basis of comprehensive treatment of gliomas,surgery is still the first and most important treatment.Studies have shown that the intraoperative total resection rate of tumor is the important factor of tumor recurrence and seizure outcome.Glioma usually grows slowly infiltrating,and the boundary of tumor is unclear which is difficult to remove the tumor totally with conventional surgery usually.At present,how to improve the resection rate of tumor as much as possible under the premise of protecting neural function is still a major problem to be solved urgently for the surgery of glioma.With the continuous development of medical and computer technology,multi-modal image fusion continues to emerge and become a research hotspot.Multi-modal image fusion is to perform registration fusion and reconstruction of different modalities of medical images to give full play of the advantages of different characteristics.As an open-source and free medical image post-processing software,3D-Slicer has been gradually used in the clinical study because of its rich multi-modal image processing functions.The software can be used to fuse and reconstruct CT/MRI/MRA/MRV/DTI and other image data and visualize the planar image to obtain 3D images of the tumor and its surrounding important tissue structures,which help us understand the spatial relationship.In the preoperative,it’s helpful to the precise location of tumors and blood vessels,important functional regions,nerve fibers,so that assist formulate the operative approach,determine tumor boundary and protect important functional structures while removing tumor.Multi-modal image fusion based on 3D-Slicer combined with real-time guidance of intraoperative neuro-navigation further meets the requirements of "precision medicine"and "personalized treatment" in the current medical development background.Objective:To explore the application value of multi-modal image fusion combined with neuro-navigation in surgery of gliomas with epilepsy in combination with the data of the gliomas with epilepsy admitted to our hospital from September 2018 to September 2020.Materials and MethodsA total of 46 gliomas with epilepsy who underwent craniotomy in the Neurosurgery Department of our hospital from September 2018 to September 2020 were collected,which clinical and follow-up data were complete.All patients were divided into experimental group（22cases）and control group（24cases）that according to whether to use multimodal image fusion combined with neuro-navigation.In the experimental group,3D-Slicer was used for preoperative images registration,fusion and 3D reconstruction of various image data.3D models of scalp,skull,tumor and its peripheral blood vessels,functional regions,nerve fibers were reconstructed by 3D-Slicer for observing the spatial position relationship and formulate the operative approach,determine tumor boundary.Fusion images were imported into the neuro-navigation system in preoperative,and removed tumor under the guidance of neuro-navigation.In the control group,patients only received traditional imaging evaluation in the preoperative,and removed tumor under the guidance of neuro-navigation.Calculate the preoperative tumor volume and residual tumor volume by 3D-Slicer,and calculate the tumor resection rate（EOR）.Postoperative epilepsy effect was graded by Engel grade at the 6th month after surgery.Statistical comparison between the two groups:the differences in tumor resection rate,postoperative seizure control situation,operation time,and factors that may affect postoperative seizure control.Results1.The good control rate of postoperative seizure in the experimental group was 90.91%,while that of the control group was 66.67%,the difference was statistically significant（P=0.038）.2.The average EOR of the experimental group was（99.74±0.01）%,while that of the control group was（98.05±0.03）%,the difference was statistically significant（P=0.017）.The AUC of the ROC curve for anticipating postoperative seizure control of EOR is 0.815,and the optimum truncation point of EOR is 98.61%,the sensitivity was 94.44%and the specificity was 70.00%（P=0.003）.3.The average operation time of the experimental group was（3.73±0.67）hours and that of the control group was（4.17±0.76）hours,the difference was statistically significant（P=0.042）.The incidence of postoperative complications was 4.55%in the experimental group,while that of in the control group was 8.33%,the difference was not statistically significant（P=1.000）.4.Single factor analysis showed:age,gender,disease course,location,side,WHO grade,tumor volume,seizure form were not correlated with the postoperative seizure control situation（P>0.05）.Total resection rate of tumor and seizure frequency correlated with the postoperative seizure control situation（P=0.027,P=0.015）.ConclusionMulti-modal image fusion based on 3D-Slicer combined with neuro-navigation can shorten the operation time of gliomas with epilepsy,significantly improve the tumor resection rate and the good control rate of postoperative seizure and assist to design the surgical approach,determine tumor boundary and determine tumor resection degree in preoperative,which has certain guiding significance for the surgery of such patients. |
PDF Full Text Request