Okonogi Shinichi, Kondo Kosuke, Harada Naoyuki, Masuda Hiroyuki, Nemoto Masaaki, Sugo Nobuo
Department of Neurosurgery (Omori), Toho University Graduate School of Medicine, 6-11-1, Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University School of Medicine, Tokyo, Japan.
Acta Neurochir (Wien). 2017 Sep;159(9):1619-1626. doi: 10.1007/s00701-017-3202-4. Epub 2017 May 15.
As the anatomical three-dimensional (3D) positional relationship around the anterior clinoid process (ACP) is complex, experience of many surgeries is necessary to understand anterior clinoidectomy (AC). We prepared a 3D synthetic image from computed tomographic angiography (CTA) and magnetic resonance imaging (MRI) data and a rapid prototyping (RP) model from the imaging data using a 3D printer. The objective of this study was to evaluate anatomical reproduction of the 3D synthetic image and intraosseous region after AC in the RP model. In addition, the usefulness of the RP model for operative simulation was investigated.
The subjects were 51 patients who were examined by CTA and MRI before surgery. The size of the ACP, thickness and length of the optic nerve and artery, and intraosseous length after AC were measured in the 3D synthetic image and RP model, and reproducibility in the RP model was evaluated. In addition, 10 neurosurgeons performed AC in the completed RP models to investigate their usefulness for operative simulation.
The RP model reproduced the region in the vicinity of the ACP in the 3D synthetic image, including the intraosseous region, at a high accuracy. In addition, drilling of the RP model was a useful operative simulation method of AC.
The RP model of the vicinity of ACP, prepared using a 3D printer, showed favorable anatomical reproducibility, including reproduction of the intraosseous region. In addition, it was concluded that this RP model is useful as a surgical education tool for drilling.
由于前床突（ACP）周围的解剖三维（3D）位置关系复杂，需要多次手术经验才能理解前床突切除术（AC）。我们从计算机断层血管造影（CTA）和磁共振成像（MRI）数据制备了一个3D合成图像，并使用3D打印机从成像数据制备了一个快速成型（RP）模型。本研究的目的是评估RP模型中3D合成图像和AC术后骨内区域的解剖再现性。此外，还研究了RP模型在手术模拟中的实用性。
研究对象为51例术前接受CTA和MRI检查的患者。在3D合成图像和RP模型中测量ACP的大小、视神经和动脉的厚度及长度，以及AC术后的骨内长度，并评估RP模型中的再现性。此外，10名神经外科医生在完成的RP模型中进行AC，以研究其在手术模拟中的实用性。
RP模型高精度地再现了3D合成图像中ACP附近的区域，包括骨内区域。此外，RP模型的钻孔是一种有用的AC手术模拟方法。
使用3D打印机制备的ACP附近的RP模型显示出良好的解剖再现性，包括骨内区域的再现。此外，得出结论，该RP模型作为钻孔手术教育工具是有用的。
