Application Of Three-dimensional Tumor-vein Fusion Model In Central Sulcus Meningioma Surgery

Objective: Central sulci meningiomas include convex meningiomas,parasagittal meningiomas,and parafalx meningioma in the area of central sulci.The tumor frequently involves the sagittal sinus,Rolando vein,Trolard vein,and other cortical draining veins,which can easily lead to venous injury during surgery,resulting in exacerbated postoperative cerebral edema,limb paralysis,and other complications,severely affecting the patient’s quality of life.This paper aims to explore the application value of venous protection during central sulcus meningioma resection by establishing a three-dimensional tumor-vein fusion imaging model.Methods: The clinical data of 45 patients with central sulcus region meningiomas who underwent microsurgical treatment in the Department of Neurosurgery,First Affiliated Hospital of the Hainan Medical College from January 2017 to December 2022 were retrospectively studied.The patients were randomly divided into A group(3D tumorvein fusion model group,n = 23)and B group(routine operation group,n = 22).All patients were examined with cranial MRI and MRV before operation,and patients in group A were examined with additional CTV before operation.In the A group,the relationship between the tumor and the drainage vein around the tumor was observed and analyzed by establishing the three-dimensional tumor-vein fusion model preoperatively with the three-dimensional reconstruction technique,the accuracy of the model was verified and the operation was guided.The patients were evaluated by routine MRI scan and MRV preoperation,and received conventional surgery in the B group.Peritumor brain tissue edema and surgical effect were dynamically observed after surgery,and clinical follow-up results were evaluated using Karnofsky functional status scoring standard.Results: CTV-tumor three-dimensional images reconstructed show abnormal out of shape in the main cortical veins(Rolando veins and Trolard veins)in this area in patients with central sulcus meningiomas.The relationship between these veins and the tumor mainly manifests as three types:(1)adjacent type,(2)displaced type,and(3)enveloped type.There were 8 adjacent type,10 displaced type,and 5 enveloped type cases in the A group,and there were 7 adjacent type,11 displaced type,and 4 enveloped type cases in the B group.Preliminary intraoperative observations showed that the main cortical veins and intrinsic tumor drainage veins had fewer anastomoses and were easier to separate in adjacent and displaced types.However,there were more anastomoses with the intrinsic tumor drainage veins in the area near the sinus(close to the tumor base),which need to be separated carefully.In the enveloped type,the cortical veins were in closer contact with the tumor surface and had a longer course on the tumor surface.Both the main trunk and the area near the sinus had more anastomoses and communications with the intrinsic tumor drainage veins,which make separation difficult and veins more susceptible to injury.The three-dimensional tumorvein fusion model has a stronger sense of depth and hierarchy compared to conventional imaging,which allow for a clearer display of the relationship between the tumor and the main venous vessels.This is in line with the actual intraoperative findings.During surgery,guided by the three-dimensional model and neuro-navigation,the surgical approach can avoid areas with dense veins,accurately locate the relevant veins,effectively guide the separation and protection of blood vessels,and reduce venous injury.Early postoperative CT scans showed no significant aggravation of peritumor brain tissue edema in the A group.The edema subsided faster in the A group than in the B group when assessed with CT and MR scans at 1-3 months postoperatively.The KPS neurological function scores in the A group were higher than those in the B group at both 7 days and 3 months postoperatively.This suggests that using a threedimensional tumor-vein fusion model to guide the surgical treatment of central sulcus meningiomas is beneficial for the precise design of surgical approaches and safe tumor removal,while maximizing the protection of the patient’s cortical drainage veins.This approach has a positive impact on postoperative neurological function recovery.Conclusions: The application of a three-dimensional tumor-vein fusion model can provide accurate and detailed anatomical information about the tumor and its surrounding major veins.This is greatly helpful for the design of personalized surgical plans,the implementation of the surgery,and the intraoperative protection of veins.