Abstract：
OBJECTIVE: This study aims to assess the efficacy and limitations of Computed Tomography Angiography (CTA)-based 3D virtual models for preoperative simulation and intraoperative neuronavigation in the surgical treatment of Distal Anterior Cerebral Artery (DACA) Aneurysms.
METHODS: A retrospective observational study was conducted, analyzing patients who underwent surgical clipping of DACA aneurysms via an interhemispheric approach from 2016 to 2022. Outcomes measured included qualitative analyses of 3D reconstructions against actual intraoperative anatomy, neuronavigator accuracy, 6-month modified Rankin Scale (mRS), complete exclusion rates, and surgical complications. Patient demographics, clinical characteristics, surgical timing, and intraoperative data were meticulously documented for analysis.
RESULTS: Fifteen patients were included in the study, with a mean age of 52 years. The mean Hunt-Hess score at admission was 2.2, encompassing 2 unruptured and 13 ruptured aneurysms. Intraoperative anatomical visualization perfectly matched the preoperative 3D model in 13 cases, with discrepancies in two. Neuronavigation demonstrated a mean accuracy of 1.76 mm, remaining consistent in 14 patients, and accurately tracking the planned trajectory. Postoperative complications occurred in 26.5 % of patients, including two fatalities, with no navigation-related complications. Incomplete aneurysm occlusion was observed in one case. The mean mRS score at 6 months was 2.46.
CONCLUSIONS: The employment of 3D CTA for preoperative simulation and intraoperative neuronavigation holds significant potential in enhancing the surgical management of DACA aneurysms. Despite some discrepancies and technical limitations, the overall precision of preoperative simulations and the strategic value of intraoperative neuronavigation highlight their utility in improving surgical outcomes.
METHODS: A retrospective observational study was conducted, analyzing patients who underwent surgical clipping of DACA aneurysms via an interhemispheric approach from 2016 to 2022. Outcomes measured included qualitative analyses of 3D reconstructions against actual intraoperative anatomy, neuronavigator accuracy, 6-month modified Rankin Scale (mRS), complete exclusion rates, and surgical complications. Patient demographics, clinical characteristics, surgical timing, and intraoperative data were meticulously documented for analysis.
RESULTS: Fifteen patients were included in the study, with a mean age of 52 years. The mean Hunt-Hess score at admission was 2.2, encompassing 2 unruptured and 13 ruptured aneurysms. Intraoperative anatomical visualization perfectly matched the preoperative 3D model in 13 cases, with discrepancies in two. Neuronavigation demonstrated a mean accuracy of 1.76 mm, remaining consistent in 14 patients, and accurately tracking the planned trajectory. Postoperative complications occurred in 26.5 % of patients, including two fatalities, with no navigation-related complications. Incomplete aneurysm occlusion was observed in one case. The mean mRS score at 6 months was 2.46.
CONCLUSIONS: The employment of 3D CTA for preoperative simulation and intraoperative neuronavigation holds significant potential in enhancing the surgical management of DACA aneurysms. Despite some discrepancies and technical limitations, the overall precision of preoperative simulations and the strategic value of intraoperative neuronavigation highlight their utility in improving surgical outcomes.
摘要：
目的：本研究旨在评估基于CT血管造影术（CTA）的3D虚拟模型在远端前动脉（DACA）动脉瘤手术治疗中用于术前模拟和术中神经导航的有效性和局限性。
方法：进行了一项回顾性观察研究，分析2016年至2022年通过半球间方法手术夹闭DACA动脉瘤的患者。测量的结果包括3D重建与实际术中解剖的定性分析，神经导航器的准确性，6个月改良Rankin量表（mRS），完全排除率，和手术并发症。患者人口统计学，临床特征,手术时机,术中数据被精心记录用于分析.
结果：15名患者被纳入研究，平均年龄52岁.入院时的平均Hunt-Hess评分为2.2，包括2个未破裂和13个破裂的动脉瘤。13例术中解剖可视化与术前3D模型完美匹配，有两个差异。神经导航显示出1.76毫米的平均精度，在14例患者中保持一致，并准确跟踪计划的轨迹。术后并发症发生率为26.5%,包括两人死亡,没有导航相关的并发症。在一例中观察到动脉瘤不完全闭塞。6个月时平均mRS评分为2.46分。
结论：采用3DCTA进行术前模拟和术中神经导航在提高DACA动脉瘤的外科治疗方面具有重要潜力。尽管存在一些差异和技术限制，术前模拟的整体精度和术中神经导航的战略价值凸显了其在改善手术结局方面的效用.
方法：进行了一项回顾性观察研究，分析2016年至2022年通过半球间方法手术夹闭DACA动脉瘤的患者。测量的结果包括3D重建与实际术中解剖的定性分析，神经导航器的准确性，6个月改良Rankin量表（mRS），完全排除率，和手术并发症。患者人口统计学，临床特征,手术时机,术中数据被精心记录用于分析.
结果：15名患者被纳入研究，平均年龄52岁.入院时的平均Hunt-Hess评分为2.2，包括2个未破裂和13个破裂的动脉瘤。13例术中解剖可视化与术前3D模型完美匹配，有两个差异。神经导航显示出1.76毫米的平均精度，在14例患者中保持一致，并准确跟踪计划的轨迹。术后并发症发生率为26.5%,包括两人死亡,没有导航相关的并发症。在一例中观察到动脉瘤不完全闭塞。6个月时平均mRS评分为2.46分。
结论：采用3DCTA进行术前模拟和术中神经导航在提高DACA动脉瘤的外科治疗方面具有重要潜力。尽管存在一些差异和技术限制，术前模拟的整体精度和术中神经导航的战略价值凸显了其在改善手术结局方面的效用.
