Anatomical analyses of far lateral approach exposing anterior part of the foramen magnum in virtual reality system / 中华神经医学杂志

Objective:To analyze the anatomical relations between operating spaces of different paths via far lateral approach and exposure of the anterior part of the foramen magnum based on data of virtual reality three-dimensional model. Methods:The CT and MRI images of 50 patients with trigeminal neuralgia, admitted to our hospital from September 2015 to January 2019 were extracted from Gamma Knife databases and inputted into Vitrea virtual reality system to establish a three-dimensional anatomy model of the posterior cranial fossa. Posterior margin of the articular surface of occipital condyle was selected as starting point to open the skull via far lateral approach; the ipsilateral sublingual neural tube opening, anterior margin of the jugular tubercle, and anterior margin of the foramen magnum were selected as the exposed targets in the base of skull bony structure; the ligatures between starting point and the 3 exposed targets were used as axis to reveal a radius of 5 mm cylinder to simulate the surgical paths exposed the anterior margin of the foramen magnum via far lateral approach, and these surgical paths were named as Path 1, 2 and 3. The operating spaces of different paths were observed, and the frequency of each path passing through certain anatomical tissues was recorded and the volume of anatomical structures was measured. Results:There were significant differences in operating space volume, bony structure and volume of lower cranial nerves among the 3 paths ( P<0.05). The operating space volume of Path 3 was significantly increased as compared with that of Path 1 and 2, and bony structure and volume of lower cranial nerves of Path 2 were significantly increased as compared with those of Path 1 and 3 ( P<0.05). Conclusion:The data collected in the surgical paths via distal lateral approach simulated by virtual reality technology can help reveal the anatomical relationship in the operating space and provide a basis for selecting the best surgical path.

A model combined machine learning with imaging omics characteristics in differentiating anaplastic glioma from glioblastoma / 中华神经医学杂志

Objective:To construct and validate a prediction model combined machine learning with imaging omics characteristics in differentiating anaplastic glioma from glioblastoma.Methods:Imaging data of 241 patients with anaplastic glioma or glioblastoma, confirmed by pathology in our hospital from August 2005 to August 2012, were retrospectively collected. These patients were divided into a training group ( n=140) and a verification group ( n=101) according to random number table method. MRIcron software was used to delineate tumor boundaries of patients from the training group on preoperative T1 enhanced MR imaging. The regions of interest (ROIs) were outlined on preoperative T1 enhanced MR imaging, and the radiomic features were extracted from ROIs by Matlab software. Least absolute shrinkage and selection operator (LASSO) regression model was used to screen the features, and then, the selected features were used to construct the prediction model by support vector machine (SVM) classifier. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of the model. Results:In these 241 patients, 101 were with anaplastic glioma and 140 were with glioblastoma confirmed by pathology. In the training group and validation group, there was statistical difference in age between patients with anaplastic glioma and glioblastoma ( P<0.05); there was no significant difference in gender distribution, tumor location, and percentages of tumor necrosis or edema between patients with anaplastic glioma and glioblastoma ( P>0.05). Totally, 431 radiomic features were extracted; 11 radiomic features were screened by LASSO regression model and the prediction model was established. The AUC of ROC curve was 0.942 and 0.875, respectively, in the training group and validation group. Conclusion:The prediction model combined machine learning and imaging omics characteristics can effectively discriminate anaplastic glioma from glioblastoma.

Morphometry of the Hand Knob Region and Motor Function Change in Eloquent Area Glioma Patients.

PURPOSE: The hand knob area is the cortical representation of motor hand function. The current study aimed to investigate the effects of eloquent area gliomas on the morphometry of the hand motor cortex and preoperative hand motor function. METHODS: A retrospective study of 320 glioma patients was conducted. Seventy-eight patients with gliomas involving motor functional area were finally enrolled. Using axial T2-weight magnetic resonance images, the width and height of the hand knob were measured in both hemispheres, and differences were compared between the affected and unaffected hemispheres. Receiver operating characteristic (ROC) curve and logistic regression analysis were used to estimate the degree of correlation between distance measurements and motor impairment. RESULTS: The width and height of the hand knob in the affected and unaffected hemispheres were significantly different (p < 0.0001). The width, height and distance from the tumor to hand knob were reduced in the functionally impaired group compared to the unimpaired group (p = 0.0003, p < 0.0001, p = 0.0005, respectively). The three parameters were significantly correlated and remained significant in ROC and logistic regression analysis. The optimal cut-off value of width, height and distance for identifying preoperative hand muscle strength were 5.73 mm, 5.80 mm and 5.92 mm, respectively. CONCLUSION: The morphometry of the hand knob is often changed by the infiltration or extrusion of the tumors that were located in or near the hand knob. The width, height of hand knob and the distance from tumor to hand knob could serve as anatomic biomarkers related to preoperative neurological motor deficits.

Impact of target exposure via retrosigmoidal approach in surgical injury measured by virtual reality skill / 中华神经医学杂志

Objective To discuss the impact of target exposure via retrosigmoidal approach in surgical injury based on virtual reality anatomic models.Methods CT and MR imaging data of 15 adult cadaver heads were utilized to establish three-dimensional anatomy models of petrous bone.Surgical routes exposing different targets though retrosigmoidal approach were simulated by selecting osseous landmark points on the calvaria and skull base.Special form and sequence of anatomic structures in different routes were observed.Volumes of anatomic tissues were measured.Results All the surgical routes passed below the transverse sinus and lateral to the cerebellum.Route a exposed the lower cranial nerve and anterior inferior cerebellar artery;when reached the jugular tubercle,the route exposed inferior petrous sinus.Route b exposed the anterior inferior cerebellar artery,labyrinth and facial-acoustic nerve complex.Route c passed the medial to the superior petrous sinus and exposed the facial-acoustic nerve complex;when being arrived at petrous apex,the route exposed the trigeminal nerve,superior cerebellar artery and cavernous sinus.The volumes of the lower cranial nerve,osseous structures,cerebellum and artery were significantly different in models adopted different routes (P＜0.05);the volume of the lower cranial nerve was as follows:route c＞route a＞route b,the volume of osseous structures was as follows:route c ＞route b＞route a,the volume of cerebellum was as follows:route b ＞route a＞route c,and the volume of artery was as follows:route a ＞route c＞route b.Venous structure involved in route a ([68.91 ±1.91] mm3) was larger than that in route c ([248.92±11.26] mm3) with statistical significance (P＜0.05),and route b did not involve venous structure.Conclusions Targets in skull base has significant impaction on the size of anatomic structures involved in the route of retrosigmoidal approach.Relationship between injury and exposure can be evaluated objectively by the volume measurement.

Anatomic research of transpetrosal-presigmoidal approach for minimally invasive exposure of jugular foramen region utilizing virtual reality skill / 中华神经医学杂志

Objective To discuss the microanatomy features of jugular foramen region in transpetrosal-presigmoidal minimally invasive approach based on virtual reality image models.Methods CT and MRI scans were performed to fifteen adult cadaver heads,and then,imaging data were inputted into Vitrea virtual reality system to establish three-dimensional anatomy models of jugular foramen region.Different minimally invasive transpetrosal-presigrnoidal approaches exposing superior edge of internal acoustic meatus (route A),anterior edge of jugular foramen (route B),and posterior edge of jugular foramen (route C) were simulated by selecting osseous landmark points.Anatomic exposures in surgical trajectory following alternation of minimally invasive approach were observed,measured and compared.Results Spacial sequence of nerves and vessels in the route simulating transpetrosal-presigmoidal approach for exposure of jugular foramen region was displayed clearly;route A had the highest location and route C was the lowest.Volumes of route and petrosal osseous structure involved in route A was the largest,and then,volumes of route and osseous structure involved in route B was larger than those in route C,with significant differences (P＜0.05).Volumes of involved venous sinus were as follow:route B＞route A＞route C,with significant differences (P＜0.05).Volumes of facial-acoustic nerve complex and anterior inferior cerebellar artery involved in route A were (53.32± 5.54) mm3 and (30.55±3.51) mm3,respectively.Volumes of lower cranial nerves involved in route B were (84.59±9.23) mm3.Conclusion There are different impacts on the osseous structures and venous sinus for the minimally invasive routes of transpetrosal-presigmoidal approach exposing different targets,of which combinations are helpful to utilize respective advantages.

Risk factors of ruptured intracranial aneurysms: a clinical study / 中华神经医学杂志

Objective To investigate the correlation of rupture risk of intracranial aneurysms with aneurysm diameter,blood pressure,neck width,gender,age,and smoking and alcohol histories of the patients.Methods Retrospective analysis of the clinical and radiological data of 928 patients with intracranial aneurysm,admitted to our hospital from January 2011 to December 2012,was performed; according to rupture situation,these patients were divide into ruptured group (n=411) and unruptured group (n=517); univariate analysis and multivaviable Logistic regression analysis were used to analyze the rupture risk of intracranial aneurysms,including aneurysm diameter,blood pressure,neck width,gender,age,and smoking and alcohol histories.Results Univariate analysis showed that there were statistical significances between the two groups on aneurysm diameter,blood pressure,aneurysm neck width,gender,smoking history (P＜0.05); multivariate Logistic regression analysis showed that aneurysm diameter was the independent risk factor of rupture of aneurysms (P=0.001).Conclusion Aneurysm diameter is a key risk of rupture for intracranial aneurysms,while rupture of intracranial aneurysms is not correlated to the blood pressure,aneurysm neck width,gender,age,and smoking and alcohol histories.