3D Slicer三维重建辅助诊治大脑前动脉多发假性动脉瘤1例  

One case of multiple pseudoaneurysms of the anterior cerebral artery diagnosed and treated with the assistance of the three-dimensional reconstruction technology of 3D Slicersoftware

作　　者：何川 谭兴实 钟琦 林晓鸿 陈尧坤 曹刚 HE Chuan;TAN Xing-shi;ZHONG Qi;LIN Xiao-hong;CHEN Yao-kun;CAO Gang(Department of Neurosurgery,Zhuhai Integrated Traditional Chinese and Western Medicine Hospital,Zhuhai 519000,China)

机构地区：[1]珠海市中西医结合医院脑外科,广东519000

出　　处：《中国临床神经外科杂志》2024年第7期446-448,共3页Chinese Journal of Clinical Neurosurgery

基　　金：珠海市中西医结合医院院级科研项目(202306)。

摘　　要：颅内创伤性假性动脉瘤(TIPA)常见于锐器穿刺损伤、交通事故等,大多数发生在颈内动脉床突段以及大脑前动脉远端分支,如胼周、胼缘动脉。本病临床少见,起病隐匿,一旦破裂出血,则后果严重。目前,此病的发病机制、诊断、处理方法尚无统一意见。本文报道1例颅眶异物穿通伤合并大脑前动脉(A3段)多发假性动脉瘤。根据颅脑CTA数据,应用3D Slicer软件进行三维重建,发现大脑前动脉分叉血管形态异常,考虑多发动脉瘤,左侧后交通动脉囊状动脉瘤,结合颅骨重建及颅内创伤血肿通道情况分析,与此次颅眶创伤通道高度重合。3D-DSA明确诊断后,采用支架辅助栓塞术治疗大脑前动脉多发假性动脉瘤,左侧后交通动脉瘤2个月后分期处理,术后恢复良好。这提示3D Slicer三维重建技术可提高CTA诊断颅内动脉瘤的敏感性和特异性,甚至接近金标准DSA;还可重建颅骨、血肿和周围骨组织,模拟手术,用于术前指导。Traumatic intracranial pseudoaneurysms(TIPA)are frequently associated with sharp instrument puncture injuries,traffic accidents,etc.Most TIPA occuRin the clinoid segment of the internal carotid artery and the distal branches of the anterior cerebral artery,such as the pericallosal and callosomarginal arteries.TIPA is rare in clinic and has an insidious onset,and once it ruptures and bleeds,the consequences are severe.Currently,there is no consensus on the pathogenesis,diagnosis,and management of this disease.This article reports a case of cranio-orbital for eign body penetrating injury combined with multiple pseudoaneurysms of the anterior cerebral artery(segment A3).According to the cranial CTA data,3D Slicer software was applied for three-dimensional reconstruction.It was discovered that the morphology of the bifurcation vessels of the anterior cerebral artery was abnormal,suggesting multiple aneurysms and a sacculaRaneurysm of the left posterior communicating artery.Combined with the analysis of skull reconstruction and the channel of intracranial traumatic hematoma,it was highly coincident with the cranio-orbital trauma channel.After definitely diagnosed by 3D-DSA,stent-assisted embolization was used to treat the multiple pseudoaneurysms of the anterior cerebral artery,and the left posterior communicating aneurysm was treated in stages two months later.The postoperative recovery was favorable.This indicates that the three-dimensional reconstruction technology of 3D Slicer software can enhance the sensitivity and specificity of CTA in diagnosing intracranial aneurysms,approaching even the gold standard DSA.It can also reconstruct the skull,hematoma,and surrounding bone tissues,simulate surgeries,and be used for preoperative guidance.

关 键 词：颅内创伤性假性动脉瘤 颅内多发动脉瘤 大脑前动脉 3D Slicer软件 三维重建技术 

分 类 号：R739[医药卫生—肿瘤] R815.2[医药卫生—临床医学]