USING PREOPERATING 3D-MODELING IN DIAGNOSTICS AND SURGICAL TREATMENT OF TERTIARY HYPERPARATHYROIDISM
Objective. To design a patient-specific preoperational 3D model of the neck anatomical formations based on MRI study to facilitate the search and removal of parathyroid adenoma in patients with tertiary hyperparathyroidism (THPT). Methods. Preoperative 3D modeling was done for 7 patients with tertiary hyperparathyroidism. All patients were on the program renal dialysis because of the terminal stage of chronic renal insufficiency. For obtaining the personified 3D model the results MRI and special software were used. Data in DICOM format were loaded in software; at the same time, individual series of MRI studies were recorded and brought to a single coordinate system, they were segmented - the selection on the images of borders of anatomical structures, and three-dimensional polygonal models of the anatomical structures of the anterior surface of the neck and pathological sites - adenomas of the parathyroid glands were designed. Results. With the use of preoperation 3D modeling the obtained models of the anatomical formations of neck allowed revealing and removing parathyroid adenomas rapidly, with the smallest time interval. The operation time on the average comprised 60±15 the minutes (M±σ). The operation effectiveness was proved by the results of laboratory investigations and clinical picture on the whole. In the postoperative period, during the following day after operation the median of ionized calcium decreased to 0.88 mmol/L (decrease by 0.32 mmol/L or on 26.7%, with r=0.00001), the median of parathyroid hormone - to 98.2 pg/ml (decrease on 2048.8 pg/ml - 95.4% with r=0.00001); the median of phosphorus - to 1.28 mmol/L (it was lowered on 0.33 mmol/L - 20.5%). The pains in the bones and the joints were clinically stopped in patients. Conclusions. The suggested method is a reliable technique of the preoperative topical diagnosis of the pathological changes of the parathyroid glands. Its use leads to the decrease of operation time and reduces the need for traumatic and time-consuming neck exploration, necessary to find 4 and more adenomas), thus reducing the risk of post-surgery complications. The given method can be used for objective visualization of parathyroid adenomas during the operation and serve as the effectiveness criterion of surgical treatment adequacy. What this paper adds The personified three-dimensional model (3D-simulation) for topical diagnostics of the adenomas of near-thyroid glands in patients with tertiary hyperparathyroidism has been suggested for the first time, made on the basis of the magnetic-resonance tomography of the neck, which makes it possible to indicate accurately the location of the affected parathyroid glands in the preoperation stage, to optimize the implementation of the operation, to find and to remove adenomas rapidly during the operation. The application of preoperation 3D-simulation reduces the time of the operation and the probability of the development of postoperative complications.