ABSTRACT
Objective As the intracranial aneurysm diagnosed by digital subtraction angiography (DSA) examination,the patient's cerebral vessels models of intracranial aneurysms were built by 3D Printer.According to the models,the size,shape,orientation of the aneurysms,as well as the relationship between the parent artery and the branch vessels were analyzed to provide reference for craniotomy.Methods The 11 patients with intracranial aneurysms diagnosed by DSA were prospectively selected in this study from May 1,2016 to June 30,2016.The DSA data of the patients were output in DICOM format,after format conversion and three-dimensional reconstruction by MIMICS software,the selected target regions were modeled by 3D printers in different proportions (1∶1 and 1∶3).Results The cerebral vascular 3D printing models could reflect the shape,size and distribution of the cerebral vascular and orientation of the intracranial aneurysms.It could also show the relationship between the aneurysm and parent arteries along with vascular branches.It was showed that the original size and different amplified model could provide reference for the aneurysm clipping surgery.Conclusion The 3D printing technology can be used into the production of human cerebral vascular models,which can provide a physical model for diagnosis and treatment of intracranial aneurysms,and it can also provide useful reference for preoperative and intraoperative aneurysm clip selection and clamping method decision during the aneurysm clip surgery.
ABSTRACT
Objective To identify the factors enhancing the contusive brain hemorrhage following unilateral decompression craniectomy in patients with severe traumatic brain injury (TBI),and to explore the relationship between the initial Rotterdam CT score and clinical outcomes.Methods A prospective study of 291 consecutive patients with TBI admitted from Jan 2008 through Dec 2012 was carried out.Patients treated with unilateral decompression craniectomy were enrolled for study.Patients without preoperative or postoperative cranial CT imaging were excluded.Of them,235 patients were followed up.Gender,age,the causes of injury,preoperative general condition including Glasgow Coma Scale (GCS) score,pupillary response,laboratory data and the initial CT scans before operation,contusion hematoma size in CT scans following operation and Glasgow Outcome Scale (GOS) score were recorded.With t test,x2 test and nonparametric rank sum test,differences in the above listed variables were compared between patients with enlarged hematoma size group and those without change in hematoma size.A Classification And Regression Tree (CART) was used to predict the size of hematoma.Correlation analysis was used to find the relationship between the Rotterdam CT scores and GOS scores.Results The differences in age (t =2.034,P =0.043),first Rotterdam CT score (Z =4.838,P ＜ 0.01),GCS score (Z =4.440,P ＜ 0.01),pupillary response (Z =3.235,P =0.001),the length of time elapsed between the trauma occurred and the decompressive craniectomy (Z =3.874,P ＜ 0.01),glucose level (Z =3.880,P ＜ 0.01) and cerebrum hernia magnitude (Z =2.529,P =0.012) were significant between the patients with hematoma expanded (n =120) and those without change in hematoma size (n =115).The results of the CART indicated that Rotterdam score got from the initial head CT,glucose level and the length of time elapsed between trauma occurred and decompressive craniectomy were strong predictors of the risk for expanded hemorrhagic contusions following decompressive craniectomy.Both age and size of the removed bone-flap also could predict the risk of postoperative expansion of hemorrhagic contusions.The overall predictive accuracy of the CART model was 83.3％.Correlation analysis results indicated that Rotterdam CT score was negatively correlated with GOS (r =-0.333,P ＜ 0.01).Conclusions Initial Rotterdam CT scores,glucose level and the length of time between trauma and decompressive craniectomy may predict the risk of contusions expansion following decompressive craniectomy.Rotterdam CT score was negatively correlated with GOS.