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分析

Efficacy analysis of simplified augmented reality technology-assisted neuroendoscopic trans-sylvian insular approach for basal ganglia hemorrhage

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。方法 回顾性分析2021年1月至2024年6月汉中市人民医院收治的78例中等量(30～70ml)基底节区脑出血患者的临床资料,按照手术方法不同分为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智能手机重曝相机App,实现简易AR技术,描记血肿和侧裂体表投影,设计手术切口及骨窗范围,神经内镜下分离侧裂至岛叶血肿清除术,显微开颅组采用小骨窗开颅显微镜下分离侧裂至岛叶血肿清除术。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内镜组与显微开颅组的一般资料差异无统计学意义(P>0.05)。AR内镜组的手术时间、术中出血量、血肿残留量和住院时间均低于小显微开颅组,差异均有统计学意义(P<0.05)。手术后两组的格拉斯哥昏迷(GCS)评分均高于术前,AR内镜组术后7d、15d、30d的GCS评分均高于显微开颅组,差异有统计学意义(P<0.05)。AR内镜组术后并发症的发生率明显低于显微开颅组,差异有统计学意义(P<0.05)。术后随访6个月,两组的美国国立卫生研究院卒中量表(NIHSS)评分均显著降低,且AR内镜组明显优于显微开颅组,差异有统计学意义(P<0.05)。AR内镜组日常生活能力评分(ADL)评分明显高于显微开颅组,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,可直观地了解血肿的位置,手术创伤小、血肿清除率高,并发症少,能提高患者的生活质量。

Abstract:

Objective? To investigate the clinical efficacy of simple augmented reality (AR)-assisted neuroendoscopic transsylvian insular approach for the treatment of basal ganglia hemorrhage.Methods? A retrospective analysis was conducted on 78 patients with moderate-volume (30–70 mL) basal ganglia hemorrhage treated at Hanzhong People,s Hospital from January 2021 to June 2024. Based on surgical methods, patients were divided into the AR-endoscopy group (n=40) and the microsurgical craniotomy group (n=38). In the AR-endoscopy group, 3D-Slicer software was used preoperatively to visualize the hematoma and sylvian fissure. The reconstructed images were imported into a smartphone app (e.g., double-exposure camera) to achieve simple AR technology, marking the hematoma and sylvian fissure for surgical incision and bone window design. Neuroendoscopic hematoma evacuation was performed via sylvian fissure dissection to the insula. The microsurgical group underwent small bone-window craniotomy with microscopic hematoma evacuation via the same approach. General data, operative time, intraoperative blood loss, residual hematoma volume, hospitalization duration, preoperative and postoperative consciousness recovery Status,postoperative complications, and prognosis were compared between the two groups.Results? No significant differences were observed in baseline characteristics between the two groups (P>0.05). The AR-endoscopy group exhibited shorter operative time, less intraoperative blood loss, lower residual hematoma volume, and reduced hospitalization duration compared to the microsurgical group (P<0.05). Postoperative Glasgow Coma Scale (GCS) scores improved in both groups, with the AR-endoscopy group showing significantly higher scores at 7, 15, and 30 days postoperatively (P<0.05). The incidence of postoperative complications in the AR endoscopy group was significantly lower than that in the microcraniotomy group, and the difference was statistically significant(P<0.05). At 6-month follow-up, both groups showed significant reductions in NIH Stroke Scale (NIHSS) scores, with the AR-endoscopy group demonstrating superior outcomes (P<0.05). Activities of Daily Living (ADL) scores were also significantly higher in the AR-endoscopy group (P<0.05).Conclusion? Simple AR-assisted neuroendoscopic transsylvian insular approach for basal ganglia hemorrhage provides intuitive visualization of hematoma localization, minimizes surgical trauma, achieves high hematoma clearance rates, reduces complications, and improves patients" quality of life.