3D打印技术在现代神经外科中的应用

3D打印技术作为新型制造技术,在医学领域已有数十年的发展历史,于各个专科均有不同程度的应用。3D打印技术高精度、个体化制作等优势使其能够应用于神经外科领域。本文简述了3D打印技术的生产过程和原理,分析其在神经外科领域各个亚专科应用的作用及意义,指出其目前还存在的不足。相信在技术发展、制度完善的前提下,该技术将给神经外科领域带来重大革新。     

3D打印技术在神经外科临床教学中的应用

3D打印技术是一类按照数字模型将材料叠加熔结在三维空间进而构造出实物的快速成型技术,目前已经在医学生物领域中得到广泛应用。神经外科临床教学内容复杂,难以在短时间内取得良好的教学效果。不断进展的影像学技术确保3D打印可应用于神经外科临床教学中,加深医学生对神经系统复杂解剖结构的理解,提供模拟神经外科手术练习,迅速掌握神经外科手术技巧,提高神经外科的教学效率,是培养优秀神经外科医生的重要途径。     

3D打印技术在神经外科的应用研究进展

正随着打印技术的不断成熟,3D打印技术在医学领域被广泛应用,并显示出巨大优势~([1～3])。本文就3D打印技术在神经外科的应用研究进展进行综述。1 3D打印技术目前,打印技术主要分四种。一是熔融沉积(fused deposition modeling,FDM)技术,通过加压喷头沉积热敏材料来重建物体。虽然现行的FDM技     

3D打印在神经外科的应用进展

随着现代科技的发展,3D打印技术已广泛应用于医学领域,在神经外科教学、科研、疑难病例诊断、复杂手术指导等方面起到越来越重要的作用。本文通过查阅相关文献,阐述3D打印技术及其在神经外科的应用进展。     

快速成型技术辅助医学影像技术在教学医院神经外科研究生教学中的实践探索

目的分析快速成型技术即3D打印辅助医学影像技术在神经外科研究生教学中的作用,探索教学新方法。方法利用医学影像技术对神经外科低年级研究生进行典型病例的教学;使用3D打印辅助医学影像技术进行二次教学。使用现场提问、调查问卷等方式评估学生对新方法的反映。结果学生普遍认为两种技术结合后,对疾病的感觉理解、空间认识能力有了很大的提升。但当前3D打印技术存在的问题,如打印时间长、不能完全模拟病变等,是限制学生认识水平进一步提升的障碍。结论在神经外科研究生教学领域,3D打印辅助医学影像技术是一个非常有潜力的教学方法,随着3D打印技术的提高,这种优势将更加明显。     

3D生物打印技术在神经系统肿瘤实验研究中的应用进展

3D生物打印作为新型生物制造技术在高分辨率生物三维结构制造方面具备独有的优势。过去10年间,该技术在器官和疾病模型的建立方面得到了广泛的应用。传统肿瘤体外模型研究通常为2D平面培养模型,细胞缺乏肿瘤微环境滋养,实验结果存在一定偏差。3D生物打印技术通过精确重塑肿瘤的异质性和肿瘤微环境的多样性,在癌症的发生、细胞增殖、转移及药物反应等研究方面得到越来越多的应用。本文对3D生物打印技术在神经系统肿瘤实验研究中的应用进展进行综述。     

3D打印技术在脑血管病中的应用进展

3D打印技术是以三维数学模型数据为基础，通过逐层叠加成实体模型的一种新型辅助 技术。脑血管病解剖结构复杂、手术操作难度大、个体化治疗要求高。随着3D打印材料及技术的发 展，3D打印技术在脑血管病领域得到了广泛的应用与发展，目前主要应用于制作脑动脉瘤、动静脉 畸形、脑动脉狭窄的血管模型，临床上可协助医师模拟培训、制订手术计划、指导手术操作，提高手 术效率、降低手术风险，未来可利用3D打印技术联合人造干细胞培养血管生物支架，为脑血管病治 疗提供新的契机。     

3D打印技术在生物医学领域的应用

<正>3D打印起源于20世纪80年代,近年来发展迅猛,被誉为"第三次工业革命的重要标志之一"。生物3D打印是3D打印的一个分支,目前正在国内外掀起新一轮研究热潮。本视频对生物3D打印作一个简要介绍。一、什么是生物3D打印生物3D打印是基于"增材制造"的原理,以特制生物"打印机"为手段,以加工活性材料包括细胞、生长因子、生物材料等为主要内容,以重建人体组织和器官为目标的跨学科跨领域的新型再生医     

3D打印技术在脑血管病中的应用进展

3D打印技术是以三维数学模型数据为基础，通过逐层叠加成实体模型的一种新型辅助
技术。脑血管病解剖结构复杂、手术操作难度大、个体化治疗要求高。随着3D打印材料及技术的发
展，3D打印技术在脑血管病领域得到了广泛的应用与发展，目前主要应用于制作脑动脉瘤、动静脉
畸形、脑动脉狭窄的血管模型，临床上可协助医师模拟培训、制订手术计划、指导手术操作，提高手
术效率、降低手术风险，未来可利用3D打印技术联合人造干细胞培养血管生物支架，为脑血管病治
疗提供新的契机。     

基于颅脑CT与MRI多模图像融合的3D打印模型制作及应用研究

目的研究基于颅脑CT与MRI图像融合的3D打印技术,制作颅脑三维虚拟模型及实体模型,探讨其在临床工作中的意义。方法利用1例小脑幕脑膜瘤患者颅脑CTA、MRI扫描所得的DICOM数据,CT图像分割重建颅骨、血管、头皮模型,MRI图像分割重建脑组织、肿瘤、脑室系统、头皮模型,以头皮模型为基准进行配准融合,完成复合三维虚拟模型的构建,优化处理后经3D打印技术制作实体模型,并邀请15名神经外科医师对模型进行独立评分。结果制作出高逼真度等比例的颅脑实体模型,问卷调查所有问题的平均分均4分。结论利用颅脑CT与MRI图像融合及3D打印技术制作的三维虚拟模型及其实体模型,对神经外科医师的疾病认识与手术应用、医患沟通、临床培训等方面有重要意义。     

The role of simulation in neurosurgery

Purpose

In an era of residency duty-hour restrictions, there has been a recent effort to implement simulation-based training methods in neurosurgery teaching institutions. Several surgical simulators have been developed, ranging from physical models to sophisticated virtual reality systems. To date, there is a paucity of information describing the clinical benefits of existing simulators and the assessment strategies to help implement them into neurosurgical curricula. Here, we present a systematic review of the current models of simulation and discuss the state-of-the-art and future directions for simulation in neurosurgery.

Methods

Retrospective literature review.

Results

Multiple simulators have been developed for neurosurgical training, including those for minimally invasive procedures, vascular, skull base, pediatric, tumor resection, functional neurosurgery, and spine surgery. The pros and cons of existing systems are reviewed.

Conclusion

Advances in imaging and computer technology have led to the development of different simulation models to complement traditional surgical training. Sophisticated virtual reality (VR) simulators with haptic feedback and impressive imaging technology have provided novel options for training in neurosurgery. Breakthrough training simulation using 3D printing technology holds promise for future simulation practice, proving high-fidelity patient-specific models to complement residency surgical learning.

     

垂体腺瘤侵袭及复发相关因素研究进展

垂体腺瘤作为临床常见的中枢神经系统内分泌肿瘤,多呈良性,部分具有侵袭性、易复发,是神经外科亟待解决的难题。其临床预后主要受生物学因素和临床因素的影响,生物学因素方面,随着阵列技术等分子病理学的应用,以及对垂体腺瘤病因学与肿瘤进展,不同亚型垂体腺瘤基因表达调控研究的深入,筛选出多种预测性、诊断分型和治疗相关预测因子和基因;临床因素方面,规范的诊断与治疗流程以及新技术的应用明显改善垂体腺瘤预后。本文拟就生物学因素和临床因素与垂体腺瘤侵袭和复发的研究进展进行简要综述。     

血管神经外科临床型研究生培养中循证医学和转化医学教育初探

目的 探讨在循证医学和转化医学在血管神经外科临床型研究生培养中的意义和方法。 方法 首都医科大学附属北京天坛医院神经外科将循证医学和转化医学教育理念引入到血管病方 向临床型研究生培养过程中,教学结束后对研究生的自主学习力、临床决策能力进行考核及评价。 结果 对血管神经外科临床型研究生进行循证医学和转化医学教育,能够培养学生的自主学习能力 并提高临床决策能力,显著缩小临床医学与基础研究之间的差距。 结论 应注重血管神经外科临床型研究生循证医学和转化医学理论及应用能力的培养。     

浅谈脑血管病融合病房的基本概念和建设框架

随着诊疗技术的发展,脑血管病的诊疗越来越多地需要其他相关学科的参与和合作,既往基于卒中单元为基础的合作模式需要更多的科室加入和更深入的合作方式。例如：缺血性卒中超急性期的再灌注治疗需要神经内科、神经外科、急诊科、神经重症监护科、神经介入科、放射科和康复科的配合;在卒中二级预防阶段,急性和亚急性期的卒中患者更强调营养支持和康复锻炼。融合性卒中单元作为卒中单元的升级模式,旨在促进神经病学、神经外科、康复部门的深入合作,以不同的合作模式,抓住分秒必争的契机,实施最佳临床实践,为患者争取更好的临床结果。探索脑血管病融合病房的初衷就是为了探索深入合作的融合病房模式,进一步加强再灌注治疗、二级预防、围手术期管理等卒中诊疗多环节的多科室协作,为构建适合不同医疗机构的卒中诊疗多科室联合模式提供参考。     

神经导航在颅内病变微创手术中的应用价值

目的探讨神经导航技术在颅内病变显微神经外科手术中的应用价值。方法32例颅内肿瘤和血管性病变患者，经术前MRI薄层扫描（1mm／层）或CT薄层扫描（1mm／层）检查，将影像数据输入Stryker导航系统工作站，进行三维重建（包括头皮、病灶、重要功能区及标志点），靶点设定，手术切口人路设计，精确定位微小病灶位置，术中神经导航引导下确定病灶位置及范围，以显微神经外科技术切除病变，术后进行临床评估和影像学评价。结果应用神经导航对颅内病变、重要结构定位准确，定位误差均在3mm以内。32例手术导航下寻找病变成功率达100％，病变全切除率达90％，同时未发生严重神经功能损害。结论神经导航系统能提供精确的术前手术人路设计和术中实时导向，减少手术创伤，提高手术效果，降低死亡率、病残率，在微创神经外科手术中具有重要的临床应用价值。     

Current educational issues in the clinical neurosciences.

OBJECTIVE: Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system. METHODS: A special symposium on current challenges in clinical neuroscience training was held at the Canadian Congress of Neurological Sciences in June 2000. Representatives from the Canadian Association of Interns and Residents, the Royal College of Physicians and Surgeons of Canada and English and French neurology and neurosurgery training programs made presentations, which are summarized in this report. RESULTS: Residency training has become less service-oriented, and this trend will continue. In order to manage the increasingly sophisticated hospital services of neurology and neurosurgery, resident-alternatives in the form of physician "moonlighters" or more permanent hospital-based clinicians or "hospitalists" will be necessary in order to operate major neuroclinical units. Health authorities and hospitals will need to recognize and assume this responsibility. As clinical experience diminishes during residency training, inevitably so will the concept of the fully competent "generalist" at the end of specialty training. Additional subspecialty training is being increasingly sought by graduates, particularly in neurosurgery. CONCLUSIONS: Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully qualified specialists in neurology and neurosurgery and the provision of optimal care to patients in clinical teaching units.     

The contributions of W.D. Stevenson to the development of neurosurgery in Atlantic Canada.

The establishment of a neurosurgical department in Halifax in January 1948 marked the beginnings of the first dedicated neurosurgical service in Atlantic Canada. The development of neurosurgery in Halifax occurred in a receptive place and time. The Victoria General Hospital, the region's largest tertiary care centre, and the Dalhousie University Faculty of Medicine were in a period of growth associated with medical specialization and departmentalization, changes inspired in part by the Flexner Report of 1910. Atlantic Canadians during this period were increasingly looking to specialists for their medical care. Although this social environment encouraged the establishment of surgical specialty services, the development of neurosurgery in Halifax, as in other parts of Canada, was closely associated with the efforts of individual neurosurgeons, such as William D. Stevenson. After training with Kenneth G. McKenzie in Toronto, Stevenson was recruited to Halifax and established the first neurosurgical department in Atlantic Canada. From the outset and over his twenty-six years as Department Head at the Victoria General Hospital and Dalhousie University, Stevenson worked to maintain the department's commitment to clinical practice, medical education, and research. Although Stevenson single-handedly ran the service for several years after its inception, by the time of his retirement in 1974 the neurosurgery department had grown to include five attending staff surgeons who performed over two thousand procedures each year. This paper highlights the importance of Stevenson's contributions to the development of neurosurgery in Atlantic Canada within the context of the social and medical environment of the region.     

神经导航系统在颅内病变手术治疗中的应用

目的 探讨神经导航系统在颅内病变显微手术中的应用效果。方法 回顾性分析2017年6月至2018年8月在神经导航系统辅助下手术切除的72例颅内病变的临床资料。结果 72例均在导航下顺利完 成手术,病灶定位准确率为100%。术后复查MRI发现,病灶全切除63 例,次全切除8例,大部分切除1例。术后症状显著好转或改善54例,无明显变化16例,加重2例。术后均没有严重的并发症,无新发神 经功能障碍,无死亡病例。72例术后随访3~12个月;复查MRI未见复发。结论 神经导航系统有助于精确定位颅内病灶,提高全切率,是显微手术切除颅内病变的有效辅助手段。     

Perspectives in pediatric neurosurgery

The new millennium beckons for novel advances in the diagnosis and treatment of pediatric neurosurgical conditions. Almost every aspect of pediatric neurosurgery has changed over the last decade. Undoubtedly with the application of knowledge in molecular biology to human disease many aspects of neurosurgery, especially neuro-oncology and the field of neuro-developmental anomalies, will change appreciably over the next decade. Overall, the trend in surgery in general and neurosurgery in particular is toward less invasive procedures and possibly non-surgical interventions. This review will briefly cover many of the important areas of pediatric neurosurgery. We will describe the state-of-the-art of our subspecialty and discuss possible future directions.