One case of multiple pseudoaneurysms of the anterior cerebral artery diagnosed and treated with the assistance of the three-dimensional reconstruction technology of 3D Slicer software
Traumatic intracranial pseudoaneurysms (TIPA) are frequently associated with sharp instrument puncture injuries,traffic accidents,etc. Most TIPA occur in the clinoid segment of the internal carotid artery and the distal branches of the anterior cerebral artery,such as the pericallosal and callosomarginal arteries. TIPA is rare in clinic and has an insidious onset,and once it ruptures and bleeds,the consequences are severe. Currently,there is no consensus on the pathogenesis,diagnosis,and management of this disease. This article reports a case of cranio-orbital foreign body penetrating injury combined with multiple pseudoaneurysms of the anterior cerebral artery (segment A3). According to the cranial CTA data,3D Slicer software was applied for three-dimensional reconstruction. It was discovered that the morphology of the bifurcation vessels of the anterior cerebral artery was abnormal,suggesting multiple aneurysms and a saccular aneurysm of the left posterior communicating artery. Combined with the analysis of skull reconstruction and the channel of intracranial traumatic hematoma,it was highly coincident with the cranio-orbital trauma channel. After definitely diagnosed by 3D-DSA,stent-assisted embolization was used to treat the multiple pseudoaneurysms of the anterior cerebral artery,and the left posterior communicating aneurysm was treated in stages two months later. The postoperative recovery was favorable. This indicates that the three-dimensional reconstruction technology of 3D Slicer software can enhance the sensitivity and specificity of CTA in diagnosing intracranial aneurysms,approaching even the gold standard DSA. It can also reconstruct the skull,hematoma,and surrounding bone tissues,simulate surgeries,and be used for preoperative guidance.
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