3D Slicer三维影像重建在颅内动脉瘤夹闭术中的应用  

Application of three-dimensional image reconstruction using 3D Slicer software to microsurgical clipping for intracranial aneurysms

作　　者：李文华 师忠杰 王占祥[1] 高鑫[1] LI Wen-hua;SHI Zhong-jie;WANG Zhan-xiang;GAO Xin(Department of Neurosurgery,The First Affiliated Hospital of Xiamen University,Xiamen 361001,China)

机构地区：[1]厦门大学附属第一医院神经外科

出　　处：《中国临床神经外科杂志》2022年第8期646-649,共4页Chinese Journal of Clinical Neurosurgery

基　　金：厦门市卫健委2020年医疗卫生重点项目(3502Z20209005)。

摘　　要：目的 探讨3D Slicer三维影像重建技术在颅内动脉瘤开颅夹闭术中的应用价值。方法 回顾性分析2020年7~9月经翼点入路开颅夹闭术治疗的12例颅内动脉瘤的临床资料。术前利用3D Slicer软件三维重建动脉瘤模型及其周围血管和部分骨性结构,并模拟手术入路,显示手术视野下动脉瘤与毗邻结构的位置关系;术中参考立体模型,寻找动脉瘤并根据解剖结构实时定位,实现精准夹闭。结果 12例均顺利完成三维影像重建,将三维模型与术中所见进行对比,9例正确反映术中真实解剖情况,3例术中对比效果欠佳,小动脉瘤(直径<5 mm)以及小血管重建效果相对较差,但是动脉瘤周围主要血管结构对比一致。12例动脉瘤均顺利实施开颅夹闭术,术中没有出现动脉瘤破裂。术后次日复查颅脑CTA示载瘤动脉通畅,未见新增出血,动脉瘤夹闭良好。术后3个月,复查CTA未见动脉瘤复发;GOS评分5分8例,4分3例,3分1例。结论 3D Slicer三维影像重建制作的颅内动脉瘤三维立体模型,可获得更多的立体解剖信息,加深对病变局部解剖的认识,指导制定手术计划,减少术中动脉瘤破裂的风险,提高手术效果。Objective To explore the application value of three-dimensional image reconstruction using 3D Slicer software to microsurgical clipping for the patients with intracranial aneurysm.Methods The clinical data of 12 patients with intracranial aneurysm who were treated with microsurgical clipping through pterional approach from July to September in 2020 were retrospectively analyzed.3D Slicer software was used to reconstruct the three-dimensional model of intracranial aneurysms and their surrounding blood vessels and skull structures before surgery,and the surgical approach was simulated to show the positional relationship between the aneurysm and the adjacent structures under the surgical field.During the operation,the aneurysms were located and searched in real time to achieve precise clipping according to the 3D reconstruction model.Results The 3D image reconstruction of aneurysms were successfully completed in all the patients.The 3D model showed real anatomy in 9 patients and poor in 3 patients by comparing with the intraoperative findings.The small vessel reconstruction was relatively poor,but the main vascular structures around the aneurysm were consistent with the intraoperative findings.All the aneurysms were clipped successfully,and no aneurysm rupture occurred during the operation.The CTA 1 day after operation showed complete clipping in all the aneurysms and patency of the parent arteries,without new hemorrhage.Three months after operation,no recurrence of aneurysm was found in CTA;GOS score of 5 was achieved in 8 patients,score of 4 in 3,and score of 3 in 1.Conclusions It can improve the surgical outcomes of patients with intracranial aneurysm using the3D model of intracranial aneurysm reconstructed by 3D Slicer software,which can obtain more anatomical information,deepen the understanding of the local anatomy of the aneurysm,guide the formulation of surgical plans,and reduce the risk of intraoperative aneurysm rupture.

关 键 词：颅内动脉瘤 显微夹闭术 3D Slicer软件 影像重建 疗效 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]