虚拟现实技术在颅内前循环动脉瘤手术设计中的应用

目的 研究虚拟现实(VR)技术在脑Willis环前循环动脉瘤手术设计中的应用价值.方法 选择Willis前循环动脉瘤患者50例,术前Hunt-Hess分级I级7例、Ⅱ级22例、Ⅲ级17例、Ⅳ级3例、V级1例.CT血管造影术(CTA)检查50例患者共发现57枚动脉瘤,其中小型动脉瘤(≤5mm) 16枚,一般型(5～15mm)28枚,大型(15～25mm) 10枚,巨大型(≥25mm)3枚.采用64排螺旋CT行头部薄层扫描血管造影,数据导入Dextroscope图像工作站进行三维重建并模拟手术操作,结合实际手术所见进行对比评价.结果 VR系统具有“身临其境”感和人机交互性,不仅可直观显示三维空间内的解剖结构,还能模拟部分手术操作,其结果与实际手术所见基本符合.对50例患者均成功实施了责任动脉瘤或主要动脉瘤瘤颈夹闭.结论 应用VR技术设计手术方案,能增加手术医生的信心,改善对复杂血管变异的辨识,使手术操作更为便捷,对于动脉瘤外科手术有积极的指导价值.

Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms

Objective To investigate the value of virtual reality (VR) technique in the surgical planning for anterior circulation aneurysms of Willis circle.Methods A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study.In preoperative Hunt-Hess scale,grade Ⅰ was designated in 7 patients,grade Ⅱ in 22,grade Ⅲ in 17,grade Ⅳ in 3,grade Ⅴ in 1 patient.Among the aneurysms,16 were small(≤5mm in diameter),28 medium (5-15mm),10 large(15-25mm) and 3 giant(≥25mm) in size.The thin-slice head scanning data were achieved by 64-slice spiral CT machine.These data was then transferred into Dextroscope image workstation.The virtual imaging system generated clear and vivid virtual images.We compared the findings between simulation surgical operation and actual operation.Results VR system make the operator felt "personally on the scene" and was able to communicate with the imaging.It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation.All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks.Conclusions The surgeons is able to be more confident,and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment.The virtual-reality system makes the actual operative procedure more concise,thus it is of positive value in surgery for intracranial aneurysm.