Objective: To evaluate the value of 640-slice 3D CT angiography (3D-CTA) plus 3D printing for improving the outcomes of surgeries for intracranial aneurysms.
Methods: Sixty patients with intracranial aneurysm were randomly divided into trial group (n=30) and control group (n=30). The control group received routine surgery, and the simulation models of the intracranial aneurysm in trial group was printed using a 3D printer using the imaging data from 3D-CTA. Using the simulation model, the surgery was designed and planned before operation (including surgical approaches and placement of clips) and simulation surgery was also conducted. The coincidence rates between preoperative and intraoperative findings of the intracranial aneurysms on 3D-CTA were compared. CT scan was performed at 1 and 3 days after the operation to detect potential cerebral infarction or bleeding associated with the operation; CTA was performed both at the same time and at 3-6 months after the operation to detect stenosis, occlusion and aneurysm clipping. The patients were followed up for 3-6 months to assess the outcomes using Glasgow Outcome Scale (GOS).
Results: The preoperative 3D-CTA findings were basically consistent with the intraoperative findings in all the 60 patients. Nine patients in the control group and 2 patients in the trial group had short-term adverse operation events; 11 patients in control group and 4 patients in trial group had long-term adverse events; 18 patients in control group and 25 patients in trial group had good neurologic function. The incidences of short-term and long-term adverse events associated with the operation was significantly lower in the trial group than in the control group (χ2=5.364, P=0.021; χ2=4.841, P=0.028), and the outcomes were significantly better in the trial group than in the control group (χ2=4.633, P=0.031).
Conclusion: The simulation model of intracranial aneurysm is helpful to improve the quality of surgery and patients outcomes.
目的: 术前通过颅内动脉瘤的全仿真模型对手术进行各种干预设计及进行“模拟手术练习”，探讨其对提高手术质量的指导作用。
方法: 将60例行开颅动脉瘤夹闭术患者随机分为干预组（n=30）和对照组（n=30），对照组按常规进行手术，干预组患者则进行头部3D-CTA扫描，并将获得的影像学数据结合3D打印技术，将动脉瘤和毗邻重要结构打印出来，制造出该动脉瘤的全仿真模型，术前通过该全仿真模型对手术进行干预设计，制定手术方案（包括手术入路、动脉瘤夹的选择、放置的位置及角度、术中注意事项等），并通过该模型进行术前“模拟手术训练”。术中观察动脉瘤3D-CTA所见与手术所见吻合度，术后第1、3天行CT检查，观察患者是否存在与手术相关的脑梗塞或出血；同时完成1次CT血管造影（CTA）检查，且在术后3~6个月对患者行数字减影血管造影（DSA）检查，观察是否存在载瘤动脉狭窄、闭塞或动脉瘤夹闭不全；术后进行3个月到半年的随访，进行格拉斯哥预后评分。
结果: 60例患者术前3D-CTA所见与手术所见基本一致，对照组9例发生近期手术相关不良事件，发生率为30.0%，干预组2例发生，发生率为6.7%；对照组11例发生远期手术相关不良事件，发生率为36.7%，干预组4例发生，发生率为14.8%；对照组18例疗效良好，良好率69.2%，干预组25例疗效良好，良好率92.6%。干预组在近期及远期手术相关不良事件发生率均显著低于对照组（χ2=5.364，P=0.021; χ2=4.841，P=0.028），预后明显优于对照组（χ2=4.633，P=0.031）。
结论: 全仿真模型对提高动脉瘤手术质量，改善患者预后有较强的指导作用，是一种可靠而有效的手段。