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目的探讨器械及脑动脉瘤的虚拟三维模型在神经介入术前模拟中的作用。方法在标准脑动脉瘤虚拟三维模型基础上,结合个体化的 DSA 资料,应用三维造型软件3D Studio MAX R3创建虚拟的个体化脑动脉瘤模型,并建立虚拟的导丝、导管、支架和弹簧圈,在计算机上进行神经介入手术前的模拟研究,并与3例患者的实际手术结果进行比较。结果 3例术前模拟确定的工作角度、导管导丝头端塑型的角度均与手术结果相同;2例(前交通动脉瘤和后交通动脉瘤各1例)所需弹簧圈数目、尺寸的模拟结果与手术结果相同,1例(颈内动脉巨大动脉瘤)瘤体的弹簧圈模拟结果比手术结果多2枚3 mm×3 cm 的三维弹簧圈,并且术中对瘤颈第2枚弹簧圈的释放进行了实时模拟调整;术后回顾性模拟显示对于瘤体较规则、体积较小的动脉瘤,其模拟方法可作为常规的模拟训练手段,对于体积较大的动脉瘤,其模拟训练方法尚需积累更多经验。结论由软件方法建立的虚拟器械及个体化的虚拟脑动脉瘤模型为神经介入的术前模拟、术中指导及介入操作技术培训提供了一种新的工具,对开展神经介入手术具有重要的实用价值。
Objective To explore the role of virtual three-dimensional models of instruments and cerebral aneurysms in simulating pre-interventional nerve intervention. Methods Based on the virtual three-dimensional model of cerebral aneurysm and the individualized DSA data, a virtual individualized model of cerebral aneurysm was created by using 3D modeling software MAX R3. A virtual guidewire, catheter, stent and coil , A computer simulation of nerve intervention before surgery and 3 patients with the actual surgical results were compared. Results The angles of the guidewire and the tip of the catheter were the same as the surgical results in the three working angles determined by the preoperative simulation. The number and size of the required coils, the number of the anterior communicating aneurysm and the posterior communicating artery aneurysm in the two cases The simulation results were the same as those of the surgical findings. One case (large internal carotid artery aneurysm) had 2 more 3 mm × 3 cm three-dimensional coils than the surgical findings, and the second intraoperative aneurysm The release of the ring was simulated in real time. Postoperative retrospective modeling showed that the simulated method could be used as a routine simulation training for the aneurysm with smaller and regular size. For larger aneurysms, the simulated training Methods still need to accumulate more experience. Conclusion The virtual instrument and individual virtual AV aneurysm model established by software method provide a new tool for the preoperative simulation of neurological intervention, intraoperative guidance and interventional technique training, which is of great practical significance for nerve interventional surgery value.