Objective To explore the appl ication of 3D nerve visual ization system in processing 2D imageinformation of human ulnar nerve acquired by series freezing tissue section, staining and scanning. And to draw the 3Danatomical atlas of human ulnar nerve through 3D Nerve visual ization software system. Methods One left ulnar nerve (frommedial fasciculus of brachial plexus to transverse carpal l igament, about 50 cm ) was taken from a fresh donated cadaver. After marked with human hair and embedded in OCT, series freezing tissue sections were made and stained with acetylchol inesterasehistochemically. Series 2D image information was obtained through high resolution scanner. Then the microstructure of ulnar nerve was reconstructed with 3D Nerve visual ization software system. Results Different cross sections of ulnar nerve have different numbers, positions and characters of the internal nerve fibers. The microstructure of ulnar nerve could be observed in magnifying visual field at any cross section after reconstructed in 3D Nerve visual ization soft ware system, which made it possible to track stereo courser of fascicles. Conclusion Reconstructed 3D Nerve visual ization software system shows the whole microstructure of ulnar nerve and the 3D stereo-structure of its internal fascicles, thus provides exact topography atlas for medical teaching and facil itates precise repair of ulnar nerve injury to improve theraputic effect.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
ObjectiveTo evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. MethodsThe clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected. The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique, then the classifying and partition of abdominal wall defects were performed, the hernia sac/ intraabdominal volume ratio was calculated, patch size was estimated, and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time, complications were recorded. ResultsA total of 48 patients with complex abdominal incisional hernia were enrolled, including 30 cases of midline abdominal incisional hernia and 18 cases of other sites. There were 13 cases of moderate hernia, 19 cases of large hernia, and 16 cases of huge hernia. The abdominal wall defect area measured by 3DV technique for the 48 patients was (92.11±60.25) cm2, the hernia sac / intraabdominal volume ratio was (7.7±5.2)%, and the actual defect area measured intraoperatively was (89.20±57.38) cm2. Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement (r=0.959, P<0.001). The operation time was (73.5±8.2) min, postoperative anal exhaust time (31.66±15.32) h, intraabdominal pressures at 24 h and 48 h postoperatively were (13.50±2.12) mmHg and (11.39±1.42) mmHg, respectively. The patient’s hospitalization time was (7.12±1.21) d. Among the 48 patients, 7 cases (14.58%) experienced complications after surgery, recovered smoothly after conservative treatment and no unplanned reoperation was required. All patients were followed up for 18–32 months with a median time of 26 months, and no long-term hernia recurrence was observed. ConclusionFrom the analysis results of this study, it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.
ObjectiveTo explore the feasibility of three-dimensional (3-D) visualization reconstruction of the medial sural artery perforator flap based on digital technology. MethodsA series of Dicom images were obtained from three healthy adult volunteers by dual source CT angiography. Then the Mimics software was used to construct the medial sural artery model and measure the indexes, including the starting position of medial sural artery, external diameters of vascular pedicle, the number of perforators, location perforated deep fascia, and the maximum pedicle length of perforators based on medial sural artery perforator flap. ResultsThe 3-D visualization reconstruction models were successfully finished with Mimics software, which can clearly display the distribution, travel, and perforating point. Thirteen perforators were found in 6 legs, which started at the popliteal artery with a mean external diameter of 2.3 mm (range, 1.9-2.7 mm). Each specimen had 1-3 perforators, which located at the site of 6.2-15.0 cm distal to popliteal crease and 2.5-4.2 cm from posterior midline. The maximum pedicle length of medial sural artery perforator flap was 10.2-13.8 cm (mean, 11.8 cm). ConclusionThe 3-D visualization reconstruction models based on digital technology can provide dynamic visualization of the anatomy of the medial sural artery for individualized design of the medial sural artery perforator flap.
ObjectiveTo comprehend the current diagnosis status and new progress of hepatic echinococcosis (HE). MethodThe literature from domestic and foreign researchers relevant diagnosis of HE in recent years was searched and summarized. ResultsThe HE was widely distributed worldwide, with extremely high mortality and disability rates, posing a serious threat to local economic development and public health. At present, in addition to the traditional and widely recognized diagnostic methods based on epidemiological histories, clinical manifestations, routine imaging, and experimental examinations, many innovative technologies based on these traditional diagnostic methods had emerged in the field of HE diagnosis, such as diagnostic prediction models constructed based on ultrasound and other imaging data, artificial intelligence, three-dimensional visual reconstruction, and circulating free DNA testing, which significantly improved the diagnosis rate of the HE. ConclusionsIn recent years, with the continuous improvement of medical level, the in-depth and perfect exploration of HE has made remarkable progress, which not only provides a new possibility for the early diagnosis of the HE, but also provides an important basis for research in related fields and the formulation of prevention and control measures. Therefore, the further promotion and application of these new techniques will aid to promote the diagnosis progress of HE and reduce its impact on population health.
ObjectivesTo systematically review the clinical efficacy of three-dimensional (3D) visualization vs. two-dimensional (2D) imaging technique in hepatectomy.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical trials which compared 3D visualization with conventional 2D imaging technique for hepatectomy from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 studies involving 953 patients were included. The results of meta-analysis showed that: compared to 2D imaging technique, 3D visualization technique could improve R0 resection rate (OR=2.91, 95%CI 1.31 to 6.43, P=0.009), had lower incidence of postoperative complication (OR=0.55, 95%CI 0.38 to 0.80, P=0.002), less amount of blood transfusion in operation (MD=–96.05, 95%CI –126.78 to –65.31, P<0.000 01), lower discrepancy range between the volume of the predicted liver resection and actual resection volume (MD=–94.38, 95%CI –185.46 to –3.30,P=0.04), shorter operation time (MD=–33.58, 95%CI –60.09 to –7.08, P=0.01), and lower intraoperative blood loss (MD=–79.70, 95%CI –139.86 to –19.53, P=0.009), the differences were statistically significant. There were no statistical differences between two groups in postoperative hospital stay time (MD=–0.75, 95%CI –2.45 to 0.95, P=0.39).ConclusionsThe current evidence shows that application of 3D visualization technique in hepatectomy can predict the liver resection volume more accurately, improve the R0 resection rate, shorten operation time, decrease intraoperative blood transfusion volume and the amount of bleeding, and reduce the incidence of postoperative complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.
The effect of deep brain stimulation (DBS) surgery treatment for Parkinson's disease is determined by the accuracy of the electrodes placement and localization. The subthalamic nuclei (STN) as the implant target is small and has no clear boundary on the images. In addition, the intra-operative magnetic resonance images (MRI) have such a low resolution that the artifacts of the electrodes impact the observation. The three-dimensional (3D) visualization of STN and other nuclei nearby is able to provide the surgeons with direct and accurate localizing information. In this study, pre- and intra-operative MRIs of the Parkinson's disease patients were used to realize the 3D visualization. After making a co-registration between the high-resolution pre-operative MRIs and the low-resolution intra-operative MRIs, we normalized the MRIs into a standard atlas space. We used a special threshold mask to search the lead trajectories in each axial slice. After checking the location of the electrode contacts with the coronal MRIs of the patients, we reconstructed the whole lead trajectories. Then the STN and other nuclei nearby in the standard atlas space were visualized with the grey images of the standard atlas, accomplishing the lead reconstruction and nerve nuclei visualization near STN of all patients. This study provides intuitive and quantitative information to identify the accuracy of the DBS electrode implantation, which could help decide the post-operative programming setting.
Objective To realize the visualization of three-dimensional microstructure of rabbit sciatic nerve bundles by micro-CT and three-dimensional visualization software Mimics17.0. Methods The sciatic nerve tissues from 6 New Zealand rabbits were divided into 2 groups (n=3), and the sciatic nerve tissues were stained by 1% (group A) and 5% (group B) Lugol solution respectively. After staining for 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, and 3.5 hours, the imaging changes of specimens were observed by light microscope and micro-CT. The clear micro-CT images were exported to the Mimics software to complete the visualization of three-dimensional microstructure of rabbit sciatic nerve according to three-dimensional reconstruction tool. Results The clear three-dimensional microstructure images could be observed in group A at 2.5 hours after staining and in group B at 1.5 hours after staining by light microscope and micro-CT. The sciatic nerve of New Zealand rabbits were divides into 3 bundles and each of them was relatively fixed. There was no obvious crossing or mergers between each bundle. The cross-sectional area of each bundle was (0.425±0.013), (0.038±0.007), and (0.242±0.026) mm2 respectively. The digital model could clearly reflect the microstructure of the sciatic nerve at all cross sections. Conclusion The internal structure of New Zealand rabbits sciatic nerve can be clearly reflected by micro-CT scanning. It provides a reliable method for establishing a nerve microstructure database with large amount specimens.