Leal André, Souza Mauren, Nohama Percy
Neurovascular Department, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil.
Post-Graduation Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Artif Organs. 2019 Jan;43(1):E9-E15. doi: 10.1111/aor.13303. Epub 2018 Oct 25.
One of the main difficulties in intracranial aneurysms (IA) surgery refers to the choice of the appropriate clip(s) to be implanted. Although the imaging exams currently available ensure visualization of IA's morphology, they do not bring an accurate reference positioning for the surgeon in executing the surgery procedure nor efficiently contribute to planning the surgery. Unfortunately, for IA's largely inaccessible regions, there is not an efficient method of treatment planning. Therefore, we propose a novel method that allows the generation of a 3D biomodel of the IA region under investigation using additive manufacturing technology (AM). Thus, a physical copy of the IA is produced and offers the surgeon a full view of the anatomy of that region of the brain. The aim of this study is the creation of a flexible 3D physical model (elastomer) through the AM technique, in order to allow the clip selection prior to the surgery. DICOM angio-CT images from eight patients who underwent IA surgery were transformed into STL format and then built on a 3D printer. Preoperative surgical clip selection was performed and then compared with those used in surgery. At the end of the study, all 3D IA biomodels were reproduced for microsurgical clipping selection and it was possible to predict the metal clip to be used in the surgery. In addition, the proposed methodology helps to clarify the surgical anatomy and to avoid excessive manipulation of the intracranial arteries and prolonged surgical time. The major advantage of this technology is that the surgeon can closely study complex cerebrovascular anatomy from any perspective using realistic 3D biomodels, which can be handheld, allowing simulation of intraoperative situations and anticipation of surgical challenges.
颅内动脉瘤（IA）手术的主要困难之一在于选择合适的待植入夹子。尽管目前可用的成像检查能够确保观察到IA的形态，但它们并未为外科医生在执行手术过程中提供准确的参考定位，也无法有效地辅助手术规划。不幸的是，对于IA大多难以触及的区域，尚无有效的治疗规划方法。因此，我们提出一种新颖的方法，该方法允许使用增材制造技术（AM）生成所研究的IA区域的三维生物模型。这样，就制作出了IA的实体副本，为外科医生提供了该脑区解剖结构的全貌。本研究的目的是通过AM技术创建一个灵活的三维实体模型（弹性体），以便在手术前进行夹子选择。将八名接受IA手术患者的DICOM血管造影CT图像转换为STL格式，然后在三维打印机上构建。进行术前手术夹子选择，然后与手术中使用的夹子进行比较。在研究结束时，所有三维IA生物模型都被复制用于显微手术夹子选择，并且能够预测手术中要使用的金属夹子。此外，所提出的方法有助于明确手术解剖结构，并避免过度操作颅内动脉和延长手术时间。这项技术的主要优点是，外科医生可以使用逼真的三维生物模型从任何角度仔细研究复杂的脑血管解剖结构，这些模型可以手持，从而能够模拟术中情况并预判手术挑战。
