The Treatment On Hypertensive Cerebral Hemorrhage By The Minimally Invasive Puncture Via Temporal Region Under The Guidance Of 3D Printer Model

Background:With the aging of population and deterioration of human living environment,the cerebrovascular diseases gradually became a difficulty posing a threat to the health of Chinese people,among which, the hypertensive cerebral hemorrhage took the lead. In recent years, with the development of medical equipment(microinstrument and bipolar coagulation ) , the surgical treatment on hypertensive cerebral hemorrhage became very popular, having a better curative effect than conservative treatment. Among which, the surgical method includes: iotomy with bone flap,small bone window craniotomy, trepanation and drainage, endoscopic intracranial hematoma evacuation, intracranial hematoma evacuation aided by neurosurgical navigation. Regarding the development of surgical treatment on hypertensive cerebral hemorrhage up to now, it either heavily wounded the patient or its equipment was too expensive to be popularized in primary hospitals and to be mastered by the junior doctors,lacking a surgical method having both the advantages of small wound, low cost and high accuracy.In recent years, with the advancement of technology, 3D printing was gradually developed,which can read the 2D data and build a 3D object in a layerwise way through a data conversion with the aid of computer. 3D printing provides anatomy information that is more visualized than the 2D digital image data, realizing the conversion of virtuality into reality , 2D into 3D, plane into solid. The doctor can directly conduct a surgical design and simulation test with the printed 3D entity model so as to expand way of thinking and to be skilled in surgical practice to ensure the success of actual surgery. Thus,3D printing technology provided an individualized and accuratized new thought and method for the clinical diagnosis and treatment of disease and it can effectively reduce the wound to patient in the process of surgery and can be fit for popularization in primary hospitals and mastering by junior doctors.To sum up, to further the development of intracranial hematoma evacuation for hypertensive cerebral hemorrhage, a further discussion about a method advantaged with high accuracy, simple design, easy operation, low demand for experience and skill of surgical performer,shortened surgery time,reduction of the intraoperative wound to patients and so on still needs to be conducted, while the progress of 3D printing technology paved the way for the feasibility of this method.Objective:To conduct a digitized design of a 3D facial model that is customized and accorded with the facial features of patients with hypertensive cerebral hemorrhage through the computer software Mimics 16.0, to print out a 3D facial model entity that is individualized and customized for the patients with hypertensive cerebral hemorrhage by using 3D printing technology, and to apply the 3D facial model entity to the clinical intracranial hematoma evacuation for hypertensive cerebral hemorrhage to treat the hypertensive cerebral hemorrhage by the minimally invasive puncture via temporal region Under the guidance of 3D printer model and examine the accuracy of the treatment on intracranial hematoma by the individualized minimally invasive puncture,treating the intracranial hematoma by the minimally invasive puncture via temporal region Under the guidance of 3D printer model to realize the individualization, precision and mini-trauma of the treatment on intracranial hematoma of the patient with hypertensive cerebral hemorrhage and to shorten the average stay of the patient with hypertensive cerebral hemorrhage and to reduce the treatment cost of them.Method:1. CT scan and 3D reconstructionA thin slice scan was conducted to intracranial hematoma of one case of a 52-years-old female patient with hypertension with 64 rows of spiral. the original CT image (DICOM format ) was imported into the special design software for 3D printing, Mimics 16.0, an image segmentation was conducted to the head and region of intracranial hematoma and a 3D-reconstruction of them was conducted, the depth and angle of puncture was precisely measured, a 3D facial model with a porous channel for puncture of extracranial segment was designed, and its data was saved as a file with a format of .stl. The reconstruction was focused on the vessels and nerves surrounding intracranial hematoma, skin of head and face, nose bridge, zygomatic arch, external acoustic foramen, ear and lateral fissure.2. 3D printing facial model and post processingThe 3D printer was used to print in a layerwise way with ABS resin as raw material, the printing technology in this paper was fully known as "fused deposit"technology,of which the fundamental principle was to heat and melt the ABS resin material by the heater, then by squeezing out the ABS resin like squeezing the toothpaste, the model was heaped up layer by layer and finally took shape.3. Treatment on intracranial hematoma by the minimally invasive puncture via temporal region Under the guidance of 3D printing facial modelThe patient was asked to take a supine position, the 3D facial model was placed on the patient’s face,then a mark was made on the left temporal region of patient along the puncture channel, it was the very puncture point. The surgical area was disinfected. After the draping and local anesthesia had been finished, a 0.5-cm transverse incision was performed at the puncture point, each layer of cortex had been cut open successively , then the printed facial model was packed with an aseptic bag and placed on the patient’s face and made to cling to patient’s skin as much as possible, the craniotomy drill was used to drill a bone hole along the puncture channel,a drainage tube for hematoma puncture was used to slowly pierce by 60mm along the puncture channel on the model (the puncture channel had a length of 70 mm in total,namely, from the extracranial segment of puncture channel to its end) till a dark red fluid can be seen to flow out,then the guide wire was withdrawn, the fluid was extracted by about 5 ml by syringe,the drainage tube was fixed and each layer of cortex was stitched when the drainage was seen to be unobstructed, then a drainage bag was connected and the incisions were in turn bound up.Result:1. With the help of 3D printing special software Mimics 16.0, the 2D image data of CT of intracranial hematoma of the patient with hypertensive cerebral hemorrhage can be reconstructed into a 3D image, the size and position of intracranial hematoma and the adjacent nerves and vessels can be distinctly displayed.2. With the help of 3D printing special software Mimics 16.0, the depth and angle of puncture of treatment on intracranial hematoma can be calculated, the puncture channel succeeded in avoiding the important vessels and nerves adjoining the hematoma, the 3D model accorded with the facial features of patient was successfully designed, and the puncture position was precisely accessed.3. Under the guidance of 3D printing facial model, the treatment on intracranial hematoma of the patient with hypertensive cerebral hemorrhage by the minimally invasive puncture via temporal region had a good postoperative recovery without causing complication, and It had a good prognosis, the patient’s average stay had been shortened and the treatment cost had been reduced.Conclusion:A 3D facial model accorded with the facial feature of the patient was designed with the aid of 3D printing technology, and the model was printed out by 3D printer to guide the puncture treatment on intracranial hematoma,making the treatment more individualized, precise and mini-trauma and reducing the patient’s pain and raising the success rate of surgical treatment, this method was easy to operate and to be popularized in primary hospitals in an effort to help the junior doctors who lacked clinical experiences to well finish the surgery of minimally invasive drilling drainagefor intracranial hematoma.