Marinho Paulo, Vermandel Maximilien, Bourgeois Philippe, Lejeune Jean-Paul, Mordon Serge, Thines Laurent
From the Division of Neurosurgery (P.M., P.B., J.-P.L., L.T.), Department of Neurosciences and Locomotive System, Lille University Medical Centre; Université Lille Nord de France (P.M., M.V., J.-P.L., S.M., L.T.); and Unité INSERM U703 (P.M., M.V., J.-P.L., S.M., L.T.), Université Lille Nord de France, CHRU de Lille, Lille, France.
Simul Healthc. 2014 Dec;9(6):370-6. doi: 10.1097/SIH.0000000000000056.
The safety and success of intracranial aneurysm (IA) surgery could be improved through the dedicated application of simulation covering the procedure from the 3-dimensional (3D) description of the surgical scene to the visual representation of the clip application. We aimed in this study to validate the technical feasibility and clinical relevance of such a protocol.
All patients preoperatively underwent 3D magnetic resonance imaging and 3D computed tomography angiography to build 3D reconstructions of the brain, cerebral arteries, and surrounding cranial bone. These 3D models were segmented and merged using Osirix, a DICOM image processing application. This provided the surgical scene that was subsequently imported into Blender, a modeling platform for 3D animation. Digitized clips and appliers could then be manipulated in the virtual operative environment, allowing the visual simulation of clipping. This simulation protocol was assessed in a series of 10 IAs by 2 neurosurgeons.
The protocol was feasible in all patients. The visual similarity between the surgical scene and the operative view was excellent in 100% of the cases, and the identification of the vascular structures was accurate in 90% of the cases. The neurosurgeons found the simulation helpful for planning the surgical approach (ie, the bone flap, cisternal opening, and arterial tree exposure) in 100% of the cases. The correct number of final clip(s) needed was predicted from the simulation in 90% of the cases. The preoperatively expected characteristics of the optimal clip(s) (ie, their number, shape, size, and orientation) were validated during surgery in 80% of the cases.
This study confirmed that visual simulation of IA clipping based on the processing of high-resolution 3D imaging can be effective. This is a new and important step toward the development of a more sophisticated integrated simulation platform dedicated to cerebrovascular surgery.
通过专门应用模拟技术，从手术场景的三维（3D）描述到夹闭应用的可视化呈现，可提高颅内动脉瘤（IA）手术的安全性和成功率。本研究旨在验证该方案的技术可行性和临床相关性。
所有患者术前均接受3D磁共振成像和3D计算机断层血管造影，以构建大脑、脑动脉及周围颅骨的3D重建模型。使用DICOM图像处理应用程序Osirix对这些3D模型进行分割和合并。这提供了手术场景，随后将其导入用于3D动画的建模平台Blender。然后可以在虚拟手术环境中操作数字化的夹子和施夹器，从而实现夹闭的可视化模拟。2名神经外科医生对10例IA患者进行了该模拟方案的评估。
该方案在所有患者中均可行。手术场景与手术视野的视觉相似度在所有病例中均为极佳，血管结构识别准确率在90%的病例中为准确。神经外科医生发现该模拟在100%的病例中有助于规划手术入路（即骨瓣、脑池开放和动脉树暴露）。90%的病例可从模拟中预测所需最终夹子的正确数量。术前预期的最佳夹子特征（即数量、形状、大小和方向）在80%的病例中在手术期间得到验证。
本研究证实基于高分辨率3D成像处理的IA夹闭可视化模拟是有效的。这是朝着开发更复杂的专门用于脑血管手术的集成模拟平台迈出的新的重要一步。
