简易增强现实技术辅助神经内镜下经侧裂岛叶入路治疗基底节区脑出血的疗效及文献回顾

Efficacy of simplified augmented reality technology-assisted neuroendoscopic lateral fissure-insula approach in treatment of basal ganglia hemorrhage: a retrospective analysis and literature review

摘要:

目的 探讨简易增强现实（AR）技术辅助神经内镜下经侧裂岛叶入路治疗基底节区脑出血的临床疗效，并结合文献回顾分析其技术优势及应用价值。方法 回顾性分析2021年1月—2024年6月汉中市人民医院收治的78例中等量（30～70 mL）基底节区脑出血患者临床资料，按照不同手术方法分为AR内镜组（40例）和显微开颅组（38例），AR内镜组术前利用3D-Slicer软件将血肿和侧裂可视化，重建后的图像通过导入手机重曝相机APP，实现简易AR技术，描记血肿范围和侧裂体表投影，设计手术切口及骨窗范围，神经内镜下分离侧裂至岛叶清除脑内血肿，显微开颅组采用小骨窗开颅显微镜下分离侧裂至岛叶进行血肿清除术。比较两组患者的一般资料、手术时间、术中出血量、血肿残留量、住院时间、手术前后意识情况、术后并发症及预后。结果 AR内镜组手术时间、术中出血量、血肿残留量和住院时间均低于显微开颅组，差异有统计学意义（P<0.05）。手术后两组格拉斯哥昏迷评分（GCS）均高于术前，AR内镜组术后GCS高于显微开颅组，差异有统计学意义（P<0.05）。AR内镜组术后并发症发生率低于显微开颅组，差异有统计学意义（P<0.05）。术后随访6个月，两组美国国立卫生研究院卒中量表评分均降低，且AR内镜组优于显微开颅组，差异有统计学意义（P<0.05）。AR内镜组日常生活能力评分高于显微开颅组，差异有统计学意义（P<0.05）。结论 简易AR技术辅助神经内镜下经侧裂岛叶入路治疗基底节区脑出血可直观地了解血肿和侧裂的位置，缩短手术时间，减少术中出血，提高血肿清除率，降低术后并发症的发生率，提高患者的生活质量。

Abstract:

Objective To investigate the efficacy of simple augmented reality （AR）-assisted neuroendoscopic lateral fissure-insula approach in the treatment of basal ganglia hemorrhage， and to analyze its technical advantages and application value through a literature review.Methods A retrospective analysis was performed for the clinical data of 78 patients with moderate-volume （30-70 mL） basal ganglia hemorrhage who were admitted to Hanzhong People's Hospital from January 2021 to June 2024， and according to the surgical approach， they were divided into AR endoscopy group with 40 patients and microsurgical craniotomy group with 38 patients. For the patients in the AR endoscopy group， 3D-Slicer software was used before surgery to visualize the hematoma and the lateral fissure， and the reconstructed images were imported into a smartphone application of double-exposure camera to use simple AR technology to delineate the hematoma and the lateral fissure and design surgical incision and bone window， while the lateral fissure and the insula were dissected under neuroendoscopy to remove intracerebral hematoma； for the patients in the microsurgical craniotomy group， the lateral fissure and the insula were dissected using small bone flap craniotomy under a microscope to remove intracerebral hematoma. The two groups were compared in terms of general data， time of operation， intraoperative blood loss， residual hematoma volume， length of hospital stay， state of consciousness before and after surgery， postoperative complications， and prognosis.Results Compared with the microsurgical craniotomy group， the AR endoscopy group had a significantly shorter time of operation， significantly lower intraoperative blood loss and residual hematoma volume， and a significantly shorter length of hospital stay （P<0.05）. Both groups had a significant increase in Glasgow Coma Scale score after surgery， and the AR endoscopy group had a significantly higher score than the microsurgical craniotomy group （P<0.05）. The AR endoscopy group had a significantly lower incidence rate of postoperative complications than the microsurgical craniotomy group （P<0.05）. At 6 months of follow-up， both groups had a significant reduction in NIH Stroke Scale score， and the AR endoscopy group had a significantly better score than the microsurgical craniotomy group （P<0.05）. The AR endoscopy group also had a significantly higher score of Activities of Daily Living than the microsurgical craniotomy group （P<0.05）.Conclusion In the treatment of basal ganglia hemorrhage， simple AR technology-assisted neuroendoscopic lateral fissure-insula approach can help to directly observe the location of the hematoma and the lateral fissure， shorten the time of operation， reduce intraoperative blood loss， improve hematoma clearance rate， reduce the overall incidence of postoperative complications， and improve the quality of life of patients.