鞍区病变3D打印模型的临床应用观察  

Clinical study of three-dimensional printing technique for lesions in sellar region

作　　者：薛亮 魏梁锋 张尚明 赵琳 王守森 Xue Liang;Wei Liangfeng;Zhang Shangming;Zhao Lin;Wang Shousen(Department of Neurosurgery, 900 Hospital of the Joint Logistics Team, Fuzhou 350025, China)

机构地区：[1]联勤保障部队第九○○医院神经外科,福州350025

出　　处：《中华解剖与临床杂志》2018年第6期513-517,共5页Chinese Journal of Anatomy and Clinics

基　　金：解放军福州总医院垂体瘤创新团队基金 (2014cxtd07).

摘　　要：目的探讨根据薄层增强扫描数据制作的鞍区占位性病变3D打印模型在术前制订手术计划和术中指导手术操作中的应用价值。方法采用前瞻性研究方法,纳入2015年3月—2017年6月解放军福州总医院神经外科15例鞍区病变患者,其中男6例、女9例,年龄40~75岁;垂体腺瘤13例,鞍结节脑膜瘤和颈内动脉床突上段动脉瘤各1例。将CTA、MRI薄层扫描数据输入Mimic软件,建立数字模型,通过3D打印机制作模型。在3D打印模型上分析病变与周围结构的解剖关系、模拟建立手术入路并进行模拟手术操作,确定手术方案。临床采用经单侧鼻孔-蝶窦入路显微手术切除垂体腺瘤13例、开颅手术切除鞍结节脑膜瘤1例、开颅手术夹闭左侧颈内动脉床突上段大型动脉瘤1例,并在手术中进一步参考和验证模型的模拟结果。结果3D打印模型上,13例垂体腺瘤在经鼻蝶入路视角下,可清晰显示鞍底隆突的形态、蝶窦的大小、气化分型、蝶窦分隔情况和蝶窦后壁形态,还可观察侧壁的骨性隆突;根据影像和3D模型观察结果进行适当地鞍底开窗,外侧缘不累及颈内动脉,上缘达到前海绵间窦,下方显露充分。1例鞍结节脑膜瘤及1例动脉瘤患者病变均与前床突关系密切,术中所见与3D打印模型所见一致。15例患者临床手术均顺利完成,术中、术后无血管及重要脑组织结构损伤、脑脊液漏、感染等并发症发生。结论3D打印模型可清晰显示鞍区病变与周围骨质、血管的关系,为术前手术方案设计提供了良好、直观的立体解剖结构观察,并可用于模拟手术操作,进而提高手术安全性和成功率。Objective To explore the application value of three-dimensional(3D) printing model of diseases in sella area based on thin-layer enhanced scanning data in preoperative planning and intraoperative guiding of operation. Methods A prospective study method was conducted in the Neurosurgery Department of Fuzhou General Hospital from March 2015 to June 2017.Fifteen patients with diseases in sella area, 6 males and 9 females, aged from 40 to 75 years old were enrolled, including 13 patients with pituitary adenomas, 1 patient of meningioma located in sella turcica tubercle and 1 patient of aneurysm located in the upper segment of the internal carotid artery, The computed tomography angiography(CTA) and MRI thin-layer scan data were input into mimic software to creat a digital model , then the model was created by 3D printer. Analyze the anatomical relationship between the lesion and the surrounding structure on the 3D printed model, simulate the surgical approach and surgical operation, and determine the surgical plan. Thirteen patients with pituitary adenomas were resected by microsurgery via unilateral nasal-sphenoidal approach, 1 patient of meningioma located in sella turcica tubercle was resected by craniotomy, and 1 patient of large aneurysm located in the upper segment of the internal carotid artery was clipped by craniotomy. All the patients were successfully operated. The simulation results of the model were further referenced and verified in operation. Results On the 3D printing model, 13 patients of pituitary adenoma can clearly show the shape of sellar eminence, sphenoidal sinus size, gasification type, sphenoidal septum and the shape of posterior wall of sphenoidal sinus, and can also observe the osseous eminence of lateral wall, under the perspective of transsphenoidal approach. According to the results of imaging and 3D model observation, appropriate sellar floor fenestration was performed. The lateral margin of the fenestration did not involve the internal carotid artery, the upper margin reached the anter

关 键 词：神经外科手术 3D打印 鞍区 实体模型 显微外科手术 

分 类 号：R651[医药卫生—外科学]