使用三维打印快速成型技术进行颅内动脉瘤栓塞术的微导管塑形：连续10例初步结果
Microcatheter Shaping for Intracranial Aneurysm Coiling Using the 3-Dimensional Printing Rapid Prototyping Technology: Preliminary Result in the First 10 Consecutive Cases.
作者信息
Namba Katsunari, Higaki Ayuho, Kaneko Naoki, Mashiko Toshihiro, Nemoto Shigeru, Watanabe Eiju
机构信息
Center for Endovascular Therapy, Division of Neuroendovascular Surgery, Jichi Medical University, Tochigi, Japan.
Department of Neurosurgery, Jichi Medical University, Tochigi, Japan.
出版信息
World Neurosurg. 2015 Jul;84(1):178-86. doi: 10.1016/j.wneu.2015.03.006. Epub 2015 Mar 14.
OBJECTIVE
An optimal microcatheter is necessary for successful coiling of an intracranial aneurysm. The optimal shape may be predetermined before the endovascular surgery via the use of a 3-dimensional (3D) printing rapid prototyping technology. We report a preliminary series of intracranial aneurysms treated with a microcatheter shape determined by the patient's anatomy and configuration of the aneurysm, which was fabricated with a 3D printer aneurysm model.
METHODS
A solid aneurysm model was fabricated with a 3D printer based on the data acquired from the 3D rotational angiogram. A hollow aneurysm model with an identical vessel and aneurysm lumen to the actual anatomy was constructed with use of the solid model as a mold. With use of the solid model, a microcatheter shaping mandrel was formed to identically line the 3D curvature of the parent vessel and the long axis of the aneurysm. With use of the mandrel, a test microcatheter was shaped and validated for the accuracy with the hollow model. All the planning processes were undertaken at least 1 day before treatment. The preshaped mandrel was then applied in the endovascular procedure. Ten consecutive intracranial aneurysms were coiled with the pre-planned shape of the microcatheter and evaluated for the clinical and anatomical outcomes and microcatheter accuracy and stability.
RESULTS
All of pre-planned microcatheters matched the vessel and aneurysm anatomy. Seven required no microguidewire assistance in catheterizing the aneurysm whereas 3 required guiding of a microguidewire. All of the microcatheters accurately aligned the long axis of the aneurysm. The pre-planned microcatheter shapes demonstrated stability in all except in 1 large aneurysm case.
CONCLUSION
When a 3D printing rapid type prototyping technology is used, a patient-specific and optimal microcatheter shape may be determined preoperatively.
目的
成功进行颅内动脉瘤栓塞术需要使用最佳的微导管。通过三维（3D）打印快速成型技术，可在血管内手术前预先确定最佳形状。我们报告了一系列初步的颅内动脉瘤治疗病例，这些病例使用的微导管形状是根据患者的解剖结构和动脉瘤形态确定的，该微导管由3D打印动脉瘤模型制造而成。
方法
基于从3D旋转血管造影获取的数据，使用3D打印机制造实体动脉瘤模型。以实体模型为模具，构建一个与实际解剖结构中血管和动脉瘤腔相同的中空动脉瘤模型。利用实体模型，形成一个微导管塑形心轴，使其与母血管的三维曲率和动脉瘤的长轴精确对齐。使用该心轴对测试微导管进行塑形，并通过中空模型验证其准确性。所有规划过程均在治疗前至少1天进行。然后将预先塑形的心轴应用于血管内手术。连续10例颅内动脉瘤采用预先规划的微导管形状进行栓塞，并评估临床和解剖学结果以及微导管的准确性和稳定性。
结果
所有预先规划的微导管均与血管和动脉瘤解剖结构匹配。7例在插入动脉瘤时无需微导丝辅助，而3例需要微导丝引导。所有微导管均准确对齐动脉瘤的长轴。除1例大型动脉瘤病例外，预先规划的微导管形状在所有病例中均表现出稳定性。
结论
使用3D打印快速成型技术时，可在术前确定针对患者的最佳微导管形状。
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