3D-Slicer软件辅助颅内巨大血栓性动脉瘤诊断和手术1例及文献复习

A Case of 3D-Slicer Assisted the Diagnosis and Surgery for Intracranial Giant Thrombotic Aneurysms and Literature Review

目的探讨3D-Slicer软件辅助颅内巨大血栓性动脉瘤及右侧大脑中动脉分叉部破裂动脉瘤的诊断和手术治疗的应用价值。方法回顾性分析1例颅内巨大血栓性动脉瘤及右侧大脑中动脉分叉部动脉瘤患者的临床资料和手术方案。术前采用3D-Slicer软件对动脉瘤、血肿及额叶占位性病变三维建模,辅助动脉瘤的诊断及术前定位和手术入路的设计。并结合文献复习颅内巨大血栓性动脉瘤及右侧大脑中动脉分叉部动脉瘤的临床特征和手术治疗方法。结果患者为54岁女性,术前CT及DSA诊断为右侧大脑中动脉分叉部动脉瘤破裂并蛛网膜下腔出血,前交通动脉瘤,右侧额叶占位性病变,术中证实右侧额叶占位性病变为前交通巨大血栓性动脉瘤,给予夹闭后切除;顺利找到并夹闭右侧大脑中动脉分叉部动脉瘤及清除颅内血肿。术后患者恢复良好,无神经功能障碍。结论颅内多发性动脉瘤开颅夹闭难度较大,风险较高,尤其合并颅内巨大血栓性动脉瘤时。3D-Slicer软件可用于术前进行多模态三维影像重建,并利用在动脉瘤开颅夹闭手术中,是一种更精准、安全、无创的有效辅助手段,可为动脉瘤手术提供定向指导,有很好的应用前景。

Objective To explore the application value of 3D-Slicer software in the diagnosis and surgical treatment of giant intracranial thrombotic aneurysms and ruptured aneurysms at the right middle cerebral artery bifurcation.Methods The clinical data and surgical plan of a patient with a giant intracranial thrombotic aneurysm and an aneurysm at the bifurcation of the right middle cerebral artery were retrospectively analyzed.The imaging reconstruction of the aneurysm,hematoma,and frontal lobe space-occupying lesions was conducted by the three-dimension technology with 3D-Slicer software to assist the lesion positioning and operative planning.The clinical features and surgical treatment of giant intracranial thrombotic aneurysm and right middle cerebral artery bifurcation aneurysm were reviewed in combination with literature.Results A 54-year-old woman was diagnosed with a ruptured aneurysm at the right middle cerebral artery bifurcation with subarachnoid hemorrhage,an anterior communicating artery,and a space-occupying lesion of the right frontal lobe by CT and DSA.The space-occupying lesion of the right frontal lobe was a large thrombotic aneurysm of the anterior communication that was clipped and resected.The right middle cerebral artery bifurcation aneurysm was successfully found and clamped,and the intracranial hematoma was cleared.The patient recovered well after the operation without neurological dysfunction.Conclusion Craniotomy and clipping of multiple intracranial aneurysms are more complicated and risky,especially when combined with giant intracranial thrombotic aneurysms.3D-Slicer software is used to reconstruct three-dimensional images before operation and assist in aneurysm craniotomy and clipping surgery.It is a more accurate,safe,non-invasive,and effective auxiliary method that can provide directional guidance for aneurysm surgery and has good application prospects.