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用于脑活检的患者特异性立体定向平台的技术准确性分析。

Analysis of the Technical Accuracy of a Patient-Specific Stereotaxy Platform for Brain Biopsy.

作者信息

Müller Marcel, Winkler Dirk, Möbius Robert, Werner Michael, Drossel Welf-Guntram, Güresir Erdem, Grunert Ronny

机构信息

Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, D-01187 Dresden, Germany.

Department of Neurosurgery, Faculty of Medicine, University Clinic of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany.

出版信息

J Pers Med. 2024 Feb 5;14(2):180. doi: 10.3390/jpm14020180.

Abstract

The use of stereotactic frames is a common practice in neurosurgical interventions such as brain biopsy and deep brain stimulation. However, conventional stereotactic frames have been shown to require modification and adaptation regarding patient and surgeon comfort as well as the increasing demand for individualized medical treatment. To meet these requirements for carrying out state-of-the-art neurosurgery, a 3D print-based, patient-specific stereotactic system was developed and examined for technical accuracy. Sixteen patient-specific frames, each with two target points, were additively manufactured from PA12 using the Multi Jet Fusion process. The 32 target points aim to maximize the variability of biopsy targets and depths for tissue sample retrieval in the brain. Following manufacturing, the frames were measured three-dimensionally using an optical scanner. The frames underwent an autoclave sterilization process prior to rescanning. The scan-generated models were compared with the planned CAD models and the deviation of the planned target points in the XY-plane, Z-direction and in the resulting direction were determined. Significantly lower ( < 0.01) deviations were observed when comparing CAD vs. print and print vs. sterile in the Z-direction (0.17 mm and 0.06 mm, respectively) than in the XY-plane (0.46 mm and 0.16 mm, respectively). The resulting target point deviation (0.51 mm) and the XY-plane (0.46 mm) are significantly higher ( < 0.01) in the CAD vs. print comparison than in the print vs. sterile comparison (0.18 mm and 0.16 mm, respectively). On average, the results from the 32 target positions examined exceeded the clinically required accuracy for a brain biopsy (2 mm) by more than four times. The patient-specific stereotaxic frames meet the requirements of modern neurosurgical navigation and make no compromises when it comes to accuracy. In addition, the material is suitable for autoclave sterilization due to resistance to distortion.

摘要

立体定向框架的使用在诸如脑活检和深部脑刺激等神经外科手术中是一种常见的做法。然而,传统的立体定向框架已被证明在患者和外科医生的舒适度以及对个性化医疗治疗日益增长的需求方面需要改进和调整。为了满足开展先进神经外科手术的这些要求,开发了一种基于3D打印的、针对患者的立体定向系统,并对其技术准确性进行了检测。使用多射流熔融工艺由PA12增材制造了16个针对患者的框架,每个框架有两个靶点。这32个靶点旨在使脑活检靶点和组织样本获取深度的变异性最大化。制造完成后,使用光学扫描仪对框架进行三维测量。在重新扫描之前,框架经过了高压灭菌过程。将扫描生成的模型与计划的CAD模型进行比较,并确定计划靶点在XY平面、Z方向以及合成方向上的偏差。在Z方向上比较CAD与打印模型以及打印模型与灭菌后模型时,观察到的偏差(分别为0.17毫米和0.06毫米)明显低于XY平面(分别为0.46毫米和0.16毫米)(<0.01)。在CAD与打印模型的比较中,合成靶点偏差(0.51毫米)和XY平面偏差(0.46毫米)明显高于打印模型与灭菌后模型的比较(分别为0.18毫米和0.16毫米)(<0.01)。平均而言,所检测的32个靶点位置的结果超过了脑活检临床所需的精度(2毫米)四倍多。针对患者的立体定向框架满足现代神经外科导航的要求,在准确性方面毫不妥协。此外,该材料由于抗变形性而适用于高压灭菌。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31fa/10890199/a040009aae21/jpm-14-00180-g001.jpg

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