颅内动脉瘤介入术前模拟的价值

目的 探讨个体化颅内动脉瘤及介入器械的虚拟三维模型在神经介入术前模拟中的价值.方法 回顾性分析17例术前模拟的结果并与实际手术对比,评价在建模及模拟时间、模拟的准确性和模拟在教学培训方面的价值.结果 (1)建立个体化模型耗时较多,实用性稍差;而术前模拟耗时不多,具有实用性.(2)模拟工作角度的准确性较高(14/17);模拟插管路径(15/17)对指导术中微导管、微导丝头端合理塑形具有参考价值;模拟填塞弹簧圈及释放支架的结果与手术结果相同或相近者占76%(13/17).(3)在加强对手术意图理解价值占93%(38/41);颅内动脉瘤个体化模型建立难度较大占54%(22/41).结论 在术前模拟的操作方法、模拟结果的准确性和教学培训方面具有较好的实用性,在优化个体化颅内动脉瘤模型的建模方法方面值得进一步研究.

Abstract：

Objective To explore the value and pitfall of virtual three - dimensional individual cerebral aneurysm and instrument models in interventional preoperative simulation.Methods The individual simulation results of 17 patients with interventional preoperative cerebral aneurysms were retrospectively analyzed and compared with the results of actual surgery.To evaluate the value and pitfall in the time - consuming of preoperative simulation and modeling, the simulation results of optimal showing angle of the aneurysm, the simulation pathway of inserting catheter, the simulation results of coil and stent placement accuracy and simulation results in teaching and training were evaluated.Results (1)The practical value of establishing individual cerebral aneurysm model was not ideal because of longer time -consuming.The practical value of preoperative simulation could be accepted because of shorter time -consuming.(2)The simulation results of optimal showing angle of the aneurysm had some practical value because the accuracy was high (14/17).The simulation results of intubation pathway had reference value to guide a reasonable micro - catheter and micro - wire tip moulding.The simulation results of packing coil and releasing stent compared with actual operation results were the same or similar (13/17).(3) Questionnaire survey results showed that the proportion in enhancing comprehension of the operative intent with a high value was 38/41, the proportion of software operation method with a high difficulty in establishing individual cerebral aneurysm model was 22/41.Conclusions In aspects of operational method of preoperative simulation, the accuracy of simulation results, the teaching and staff training have better practicability.In aspects of optimizing the individual modeling method of cerebral aneurysm is worth further study.

Value and pitfall of interventional preoperative simulation in cerebral aneurysm

Objective To explore the value and pitfall of virtual three - dimensional individual cerebral aneurysm and instrument models in interventional preoperative simulation.Methods The individual simulation results of 17 patients with interventional preoperative cerebral aneurysms were retrospectively analyzed and compared with the results of actual surgery.To evaluate the value and pitfall in the time - consuming of preoperative simulation and modeling, the simulation results of optimal showing angle of the aneurysm, the simulation pathway of inserting catheter, the simulation results of coil and stent placement accuracy and simulation results in teaching and training were evaluated.Results (1)The practical value of establishing individual cerebral aneurysm model was not ideal because of longer time -consuming.The practical value of preoperative simulation could be accepted because of shorter time -consuming.(2)The simulation results of optimal showing angle of the aneurysm had some practical value because the accuracy was high (14/17).The simulation results of intubation pathway had reference value to guide a reasonable micro - catheter and micro - wire tip moulding.The simulation results of packing coil and releasing stent compared with actual operation results were the same or similar (13/17).(3) Questionnaire survey results showed that the proportion in enhancing comprehension of the operative intent with a high value was 38/41, the proportion of software operation method with a high difficulty in establishing individual cerebral aneurysm model was 22/41.Conclusions In aspects of operational method of preoperative simulation, the accuracy of simulation results, the teaching and staff training have better practicability.In aspects of optimizing the individual modeling method of cerebral aneurysm is worth further study.