三维精准手术计划对减少高Hunt-Hess分级动脉瘤夹闭术中并发症的意义  

Application of three-dimension preoperative simulation in reducing adverse event in ruptured intracranial aneurysm with severe intracranial hemorrhage

作　　者：刘展[1] 陶胜忠[1] 王艮卫[1] 王在斌 耿晓腾 马帅 张栋韬 尹梦磊 LIU Zhan;TAO Shengzhong;WANG Genwei;WANG Zaibin;GENG Xiaoteng;MA Shuai;ZHANG Dongtao;YIN Menglei(Department of Neurosurgery,The Secondary Affiliate Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院神经外科,郑州450000

出　　处：《实用医学杂志》2023年第14期1779-1785,共7页The Journal of Practical Medicine

基　　金：河南省高等学校重点科研项目(编号:21B320011)。

摘　　要：目的探讨术者在进行合并严重颅内血肿的前循环动脉瘤夹闭时,能否在三维个体化的精准手术计划指导下,减少术中并发症的发生。方法使用3D Slicer软件对23例高Hunt-Hess分级的前循环动脉瘤患者术前CT和CTA图像进行融合及三维体绘制重建,制定精确的个体化手术方案并指导动脉瘤夹闭术,并比较规划手术中与实际术中发现的一致性。结果按照精准手术方案进行头位摆放和开颅,能明显减少术中对患者头位的调整及因术野狭窄而二次磨除蝶骨嵴;规划术野中显示的瘤颈形态、瘤颈瘤体过渡区薄弱部位以及瘤颈旁细小动脉对实际术中发现判断的灵敏度分别为90%、50%和75%,特异度分别为100%、100%和93.3%,Kappa值分别为0.701、0.623和0.732;规划夹闭方式对实际夹闭方式判断的灵敏度为100%,特异度25%,Kappa系数0.355。结论三维个体化的精准手术计划,能有效帮助术者对合并大量颅内出血的前循环动脉瘤手术夹闭过程做出精确预判,有利于减少术中并发症。Objective To investigate whether precise surgical planning based on multimodal image fusion and 3D reconstruction technology can reduce adverse events during clipping in patients suffered from ruptured intracranial anterior circulation aneurysm with severe subarachnoid or intracephalic hematoma.Methods Using 3D Slicer 4.10.2,multimodal image fusion and 3D reconstruction were performed basing on preoperative CT and CTA images of 23 patients with high-grade Hunt-Hess grade anterior circulation ruptured aneurysms.According to personalized surgical plan its guiding to craniotomy aneurysm clipping,we compare the consistency of preoperative three-dimensional imaging results with the actual observation during operation,and evaluate its pros and cons for reducing intraoperative adverse events.Results Accurately guided by the preoperative simulated the head position and craniotomy,we can significantly reduce the adjustment of the patient's head position during the operation and the secondary grinding off the sphenoid ridge due to poor exposure of the sylvian fissure.According to the intraoperative observation,the sensitivities of the aneurysm neck shape,the poor parts of the transition zone of the aneurysm's neck to body,and the small perforating vessels beside the neck displayed in the 3D images were 90%,50%,and 75%,respectively,and the specificities were 100%,100%,and 75%,respectively.Kappa coefficients were 0.701,0.623 and 0.732,respectively.The sensitivity and the specificity of preoperative simulated clipping for the actual intraoperative clipping was 100% and 25% respectively,and the Kappa coefficient was 0.355.Conclusion The precise plan based on preoperative multimodal image fusion and 3D reconstruction technology can effectively help the surgeon to accurately individualize the craniotomy clipping of ruptured anterior circulation aneurysm with severe subarachnoid hemorrhage or intracephalic hematoma and reduce the incidence of intraoperative adverse events.

关 键 词：脑动脉瘤 动脉瘤夹闭 术中并发症 HUNT-HESS分级 三维重建 

分 类 号：R651.12[医药卫生—外科学]