个体化定制3D打印定位导板辅助显微手术切除幕上脑肿瘤

Clinical effcacy of customized 3D printing positioning guide plate assisted microsurgery for resection of supratentorial brain tumors

目的探讨基于CT与MRI多模态影像的3D打印技术辅助显微手术切除幕上脑肿瘤的可靠性与安全性。方法回顾性分析2021年6月至2022年6月手术切除的56例幕上脑肿瘤的临床资料。27例采用导航引导(导航组),29例采用3D打印导板定位辅助(3D打印组)。个体化3D打印导板定制流程:将术前CT、MRI等影像的DICOM格式的原始数据,发送至医学3D打印中心数据库,进行影像多模态融合并三维建模,清晰显示病灶与邻近重要血管神经的毗邻关系;根据模型进行手术路径合理规划,再利用手术路径与颅表特定部位关系,设计定位导板。结果两组病人均顺利完成手术,无手术死亡病例。3D打印组定位耗费时间较导航组明显缩短(P<0.05),但两组病灶精准度优良率、病灶全切除率、术后3月GOS评分均无统计学差异(P>0.05)。结论多模态影像融合3D打印技术可获得个体化的脑肿瘤三维实物模型和手术定位导板,能很好地指导手术切除幕上脑肿瘤,可替代部分神经导航的功能。

Objective To explore the reliability and safety of 3D printing technology based on multimodal CT and MRI images in facilitating microsurgical resection of supratentorial brain tumors.Methods The clinical data of 56 patients with supratentorial brain tumors underwent surgical resection from June 2021 to June 2022 were retrospectively analyzed.Of these 56 patients,27 patients underwnt surgery guided by neuronavigation system(neuronavigation group)and 29 guided by 3D printing positioning guide plate(3D printing group).The individualized customization process of 3D printing guide plates entailed:The original data in DICOM format of preoperative CT,MRI and other images were dispatched to the database of the medical 3D printing center for multimodal image fusion and three-dimensional modeling,thereby clearly delineating the adjacent relationship between the lesion and adjacent significant blood vessels and nerves.Based on the model,the surgical path was rationally planned,and subsequently,the positioning guide plate was designed by exploiting the relationship between the surgical path and specific areas of the cranial surface.Results The patients in both groups successfully completed the operations without surgical death.The positioning time in the 3D printing group was significantly shorter than that in the navigation group(P<0.05).However,there were no significant differences in lesion accuracy,total resection rate,and GOS score at the three-month follow-up between the two groups(P>0.05).Conclusions Multi-modal image fusion with 3D printing technology can generate personalized physical models of brain tumors and provide surgical positioning guidance,effectively facilitating supratentorial brain tumor resections.This approach may serve as a viable alternative to certain aspects of the neuronavigation system.