脑动脉瘤虚拟三维模型介入术前的模拟研究

Study on interventional preoperative simulation of virtual three-dimensional cerebral aneurysm models

目的应用三维造型软件建立脑动脉瘤虚拟三维模型，探讨其在神经介入术前模拟中的作用。方法选取具有代表性的正常脑血管和脑动脉瘤的DSA资料作为蓝本，利用三维造型软件3D Studio MAX R3分别创建虚拟的脑动脉系统、脑动脉瘤体以及导丝、导管和弹簧圈模型，在计算机上进行神经介入手术前的模拟研究。结果（1）能够提高医生对瘤体与脑动脉之间的三维空间关系及导管走行方向的认识；（2）术前可以建立个体化的虚拟模型，协助医生确定术中投照角度；（3）能够预先计划插管路径、弹簧圈放置的尺寸、位置和数量，并对导管、导丝头端合理塑型；（4）能够作为低年资医师的模拟培训平台。结论脑动脉瘤虚拟三维模型为神经介入的术前模拟提供了一种新的研究方法，对于医师培训和指导介入插管操作具有参考作用。

Objective To establish virtual three-dimensional cerebral aneurysm models by using three-dimensional moulding software, to explore the effect of the models in interventional preoperative simulation. Methods The virtual model including cerebral arteries and aneurysms with various kinds of shape were established by using the three-dimensional moulding software of 3D Studio MAX R3 with normal cerebral DSA image and cerebral aneurysms DSA image as the original. After the establishment process of catheter, guide wire and coil, the interventional preoperative simulation was run in personal computer. Results （ 1 ） The virtual models could assist doctor to improve the recognition of three-dimensional spatial relation between cerebral arterial system and aneurysms, and to emphasize the course in vessel of catheter and guide wire. （2）The individual virtual models of cerebral arterial system and aneurysms could be established before operation, and assist doctor to determine the optimal showing angle of the aneurysmal shape and neck for operation according to the results of preoperative simulation. （ 3 ） The virtual models could assist doctor to make plans in advance for the pathway of inserting catheter, and to evaluate the coil size, location and number that needed to put into aneurysms, and to mould the head of catheter and guide wire reasonably. （4）The virtual models could assist resident physician to simulate study as the training platform. Conclusion The virtual three-dimensional cerebral aneurysm models that were established by the general software provided a new study method for neuro-interventional preoperative simulation, and played an important role in doctor＇s training and interventional operation.