Application Of Multi-mode Image Fusion And Reconstruction In Microsurgical Anatomy Of Vestibular Schwannoma

Objective: Through multi-mode image fusion and reconstruction technology,we aim to study the anatomical relationship between tumor and adjacent structures in order to facilitate the preoperative evaluation,maximize the resection extent and preserve critical structures.Methods: 22 cases of vestibular schwannoma,including 6 male patients and 16 female patients,treated by neurosurgery department in Wuhan Union Hospital from 2017 to 2020 were selected.And the study fused the preoperative images of magnetic resonance(MR)and computerized tomography(CT),and reconstructed three dimensional models by the software(Brain Lab i Plan Stereotaxy 3.0).Anatomical measurements were performed corresponding on both tumor and healthy sides.Results:(1)On the healthy side,the distance between ends adjacent to brain stem of facial nerve and each of the cranial nerves including the fifth,the sixth,the eighth and the ninth was measured as below.The average distance between trigeminal nerve and facial nerve was 7.53±0.71 mm.Observed values of the abducent nerve and the vestibulocochlear nerve were 8.81±0.25 mm and 2.14±0.32 mm,respectively.The average of glossopharyngeal nerve and facial nerve were 8.37±0.34 mm.(2)On the side with tumor,facial nerves of seven patients were located in anterior superior portion of vestibular schwannoma,thirteen in anterior middle portion,and two in the anterior inferior portion.The anterior inferior cerebellar artery was located in inferior pole of the tumor in 5 cases,11 cases in interior inferior portion,5 cases in interior middle portion,and 1 case in interior superior portion.Petrosal vein was in superior pole of tumor in 12 cases,9 cases in anterior superior portion,and 1 case in anterior middle portion.(3)On the side of tumor,average diameters of cranial artery segments adjacent to facial nerve were measured as below.The mean of anterior inferior cerebellar artery was 1.42±0.16 mm.Posterior inferior cerebellar artery was 1.27±0.37 mm,and vertebral artery was 2.44±0.41 mm.(4)Among 44 latus petrosal veins in 22 patients,we found 12 latus with single branch,24 latus with two branches,and 8 latus with three branches.In the classification of petrosal vein according to the relation of abouchement on superpetrosal sinus and internal auditory canal,petrosal veins include lateral,middle and medial types,and the outcome shows 4,10,and 30 respectively.Conclusion: The anatomical relationship between vestibular schwannoma and nearby normal structures is complicated.This study,through preoperative model reconstruction and intraoperative confirmation,provides a microanatomical basis for vestibular schwannoma neurosurgery,and helps to identify and protect important structures such as facial nerve and petrosal vein during surgery.Therefore,it is of great significance for the microsurgical treatment of vestibular schwannoma...