3D Slicer软件辅助大脑中动脉M4段动脉瘤手术1例及文献复习
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摘要
目的探讨远端大脑中动脉瘤的临床特征、治疗和手术方案。方法回顾性分析1例大脑中动脉远端动脉瘤患者的临床资料和手术方案。并结合复习该型动脉瘤的相关文献分析其发病特点、临床表现和治疗策略。结果患者为男性62岁,经CTA诊断为右侧远端中动脉M4段动脉瘤,合并颞叶血肿;术前神经功能障碍程度轻。采用3D Slicer软件对动脉瘤和血肿进行三维建模,辅助定位和手术设计,术中动脉瘤顺利找到并切除。术后患者的神经功能障碍恢复。结论远端大脑中动脉瘤颅内血肿和神经功能障碍的发生率高,血管分支结构复杂且变异率高;病变藏于岛盖内或皮层下脑组织中,定位和手术非常困难。3D Slicer软件重建较传统影像学检查和导航技术具有更高的可视化和便利性,对提高该型动脉瘤的手术效果具有重要意义。
Objective To study the clinical characteristics and surgical modality of the distal middle cerebral artery aneurysms(Mdist As). Methods The clinical data and surgical method of a patient with MdistAs were analyzed retrospectively. Also the literature related to the MdistAs which includes a large patient cohort was searched to analyze its morbidity,manifestations and treatment strategy. Results A 62-year-old male patient with minor neurological dysfunction was diagnosed as MdistAs at the M4 segment by CTA,which revealed the co-existing temporal lobe hematoma. The imaging reconstruction of the aneurysm and hematoma was conducted by the three dimension technology with 3D Slicer software to assist the lesion positioning and operative planning,which led to the successful resection of the aneurysm and complete neurological recovery. Conclusion The morbidity of Mdist As has been found to be rare. The common presentation with intracranial hematoma and neurological dysfunctions,the complex vascularity with a high rate of variation,and the location of the aneurysmal sac embedded under the operculum and cortex make MdistAs extremely difficult to locate and treat. 3D Slicer, which is more advantageous in the image visualization and convenience compared with the conventional imaging technique,is likely to play a vital role in the treatment of such particular aneurysm.
Objective To study the clinical characteristics and surgical modality of the distal middle cerebral artery aneurysms(Mdist As). Methods The clinical data and surgical method of a patient with MdistAs were analyzed retrospectively. Also the literature related to the MdistAs which includes a large patient cohort was searched to analyze its morbidity,manifestations and treatment strategy. Results A 62-year-old male patient with minor neurological dysfunction was diagnosed as MdistAs at the M4 segment by CTA,which revealed the co-existing temporal lobe hematoma. The imaging reconstruction of the aneurysm and hematoma was conducted by the three dimension technology with 3D Slicer software to assist the lesion positioning and operative planning,which led to the successful resection of the aneurysm and complete neurological recovery. Conclusion The morbidity of Mdist As has been found to be rare. The common presentation with intracranial hematoma and neurological dysfunctions,the complex vascularity with a high rate of variation,and the location of the aneurysmal sac embedded under the operculum and cortex make MdistAs extremely difficult to locate and treat. 3D Slicer, which is more advantageous in the image visualization and convenience compared with the conventional imaging technique,is likely to play a vital role in the treatment of such particular aneurysm.
引文
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[15]武琛,孙正辉,王芙昱,等.颅内远端动脉瘤的外科治疗[J].中华医学杂志,2014,94:698.
[16]Burkhardt JK,Yousef S,Tabani H,et al.Combination superficial temporal artery-middle cerebral artery bypass and M2-M2reanastomosis with trapping of a stented distal middle cerebral artery aneurysm:3-Dimensional operative video[J].Operat Neurosurg,2018,15:e67.
[17]Heros RC,Fritsch MJ.Surgical management of middle cerebral artery aneurysms[J].Neurosurgery,2001,48:780.
[18]Hou YZ,Ma LC,Zhu RY,et al.i Phone-Assisted augmented reality localization of basal ganglia hypertensive hematoma[J].World Neurosurg,2016,94:480.
[19]孙国臣,陈晓雷,余新光.基于简易虚拟现实和增强现实定位的内镜辅助下清除幕上自发性脑内血肿[J].中华神经外科杂志,2017,33:15.
[20]Ye L,Chen XL,Wang N.A wearable mixed-reality holographic computer for guiding external ventricular drain insertion at the bedside[J].J Neurosurg,2018,128:1.
[2]Tsutsumi K,Horiuchi T,Nagm A,et al.Clinical characteristics of ruptured distal middle cerebral artery aneurysms:Review of the literature[J].J Clin Neurosci,2017,40:14.
[3]Baltacioglu F,Cekirge S,Saatci I,et al.Distal middle cerebral artery aneurysms.Endovascular treatment results with literature review[J].Interv Neuroradiol,2002,8:399.
[4]Calvacante T,Derrey S,Curey S,et al.Distal middle cerebral artery aneurysm:A proposition of microsurgical management[J].Neurochirurgie,2013,59:121.
[5]Woo Jin Choi,Gi Taek Yee,Moon Jun Sohn,et al.Distal middle cerebral artery aneurysm[J].Kor J Cerebrovascular Surgery,2005,7:333.
[6]Horiuchi T,Tanaka Y,Takasawa H,et al.Ruptured distal middle cerebral artery aneurysm[J].J Neurosurg,2004,100:384.
[7]Joo SP,Kim TS,Choi JW,et al.Characteristics and management of ruptured distal middle cerebral artery aneurysms[J].Acta Neurochir(Wien),2007,149:661.
[8]Anno T,Kobayashi N,Yamaguchi T.Unruptured arteriosclerotic aneurysm in the distal middle cerebral artery:A case report[J].No Shinkei Geka,2018,46:493.
[9]Watanabe M,Abe E,Ishimoto R,et al.Dissecting aneurysm of the distal middle cerebral artery formed the out pouch during long-term follow-up:A case report[J].No Shinkei Geka,2018,46:415.
[10]Rinne J,Hernesniemi J,Niskanen M,et al.Analysis of 561 patients with 690 middle cerebral artery aneurysms:anatomic and clinical features as correlated to management outcome[J].Neurosurgery,1996,38:2.
[11]Matsukawa H,Kamiyama H,Miyazaki T,et al.Surgical treatment of middle cerebral artery aneurysms:the aneurysm location and size ratio as risk factors for the neurological worsening and ischemic complications[J].World Neurosurg,2018,117:e563.
[12]Ahn JY,Han IB,Joo JY.Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral haemorrhage[J].Acta Neurochir(Wien),2005,147:1287.
[13]Ding D,Bok AP.Acute subdural hematoma from a ruptured aneurysm of the distal middle cerebral artery[J].J Neurosci Rural Pract,2017,8:152.
[14]Ninomiya K,Fukasawa M,Kawakami Y,et al.Nontraumatic convexal subarachnoid hemorrhage accompanied by sylvian hematoma:an autopsy case of ruptured distal middle cerebral artery aneurysm[J].Am J Forensic Med Pathol,2018,39:54.
[15]武琛,孙正辉,王芙昱,等.颅内远端动脉瘤的外科治疗[J].中华医学杂志,2014,94:698.
[16]Burkhardt JK,Yousef S,Tabani H,et al.Combination superficial temporal artery-middle cerebral artery bypass and M2-M2reanastomosis with trapping of a stented distal middle cerebral artery aneurysm:3-Dimensional operative video[J].Operat Neurosurg,2018,15:e67.
[17]Heros RC,Fritsch MJ.Surgical management of middle cerebral artery aneurysms[J].Neurosurgery,2001,48:780.
[18]Hou YZ,Ma LC,Zhu RY,et al.i Phone-Assisted augmented reality localization of basal ganglia hypertensive hematoma[J].World Neurosurg,2016,94:480.
[19]孙国臣,陈晓雷,余新光.基于简易虚拟现实和增强现实定位的内镜辅助下清除幕上自发性脑内血肿[J].中华神经外科杂志,2017,33:15.
[20]Ye L,Chen XL,Wang N.A wearable mixed-reality holographic computer for guiding external ventricular drain insertion at the bedside[J].J Neurosurg,2018,128:1.