3D打印技术在听神经瘤个性化手术治疗中的应用研究

Application of three-dimensional printing technology in the customized treatment of acoustic neuroma

目的研究基于颅脑螺旋CT增强扫描的三维虚拟模型及其3D打印实体模型在听神经瘤手术治疗中的应用。方法利用5例听神经瘤患者颅脑螺旋CT增强扫描所得的DICOM数据,分割颅骨、血管、肿瘤等不同组织并进行数据信息提取和三维重建,在同一坐标系下实现装配融合形成三维虚拟模型,优化处理后,经3D打印技术制作实体模型,用以辅助患者手术治疗,同时邀请18位不同年资的神经外科医师对模型进行独立评分。结果 5例患者均重建三维虚拟模型并制作出听神经瘤实体模型,可直观地了解肿瘤与颅骨、内听道及周边血管的关系。医师根据实体模型,术前制定个性化的手术预案,术中参考模型,5例患者手术均获得成功,医师对问卷调查所有问题的评分均大于4分。结论基于颅脑螺旋CT增强扫描的三维虚拟模型及其实体模型,可有效指导医师制定完善的个性化手术方案,减少术中损伤,提高手术成功率。

Objective To explore the application of 3D virtual model based on enhanced spiral CT scan and the solid model of 3D printing in the surgical treatment of acoustic neuroma. Methods DICOM data of 5 patients with acoustic neuroma were acquired by enhanced spiral CT scan. Skull, blood vessels, tumors and other tissues were segmented for data extraction and three-dimensional reconstruction. The virtual three-dimensional models were created in the same coordinate system, and the solid models were made after optimization. Then they were applied in the surgical treatment of the patients. Eighteen surgeons were invited to independently evaluate the model via survey. Results The three-dimensional models of the 5 patients were successfully reconstructed and the solid ones were made for surgeons to master the relationship between tumor and the skull, the internal auditory canal and surrounding blood vessels. The solid models offered customized surgical plan and intraoperative reference. The operation of the 5 cases were successful and the scores of the evaluation from the 18 surgeons were all over 4 points. Conclusion Threedimensional virtual model and solid models based on enhanced spiral CT scan could effectively guide surgeons to develop a comprehensive personalized surgery plan, reduce intraoperative injury and improve the success rate of operation.