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Neurological Surgery No Shinkei Geka Volume 52, Issue 2 （March 2024）

Neurological Surgery 脳神経外科 52巻2号（2024年3月発行）

Japanese English

特集 ITを駆使した術前シミュレーション—トラブル回避と時短手術習得

Ⅰ 術前シミュレーションの概要

血管内治療のためのシミュレーション Simulation for Endovascular Treatment 加藤直樹 ¹ , 藤村宗一郎 ^2,3 , 佐野透 ¹ , 榎本弘幸 ¹ , 府賀道康 ¹ , 長山剛太 ¹ , 畑岡峻介 ¹ , 菅一成 ¹ , 石橋敏寛 ¹ , 村山雄一 ¹ Naoki KATO ¹ , Soichiro FUJIMURA ^2,3 , Tohru SANO ¹ , Hiroyuki ENOMOTO ¹ , Michiyasu FUGA ¹ , Gota NAGAYAMA ¹ , Shunsuke HATAOKA ¹ , Issei KAN ¹ , Toshihiro ISHIBASHI ¹ , Yuichi MURAYAMA ¹ ¹東京慈恵会医科大学脳神経外科 ²東京理科大学工学部機械工学科 ³東京慈恵会医科大学総合医科学研究センター先端医療情報技術研究部 ¹Department of Neurosurgery, The Jikei University School of Medicine ²Department of Mechanical Engineering, Faculty of Engineering, Tokyo University of Science ³Division of Innovation for Medical Information Technology, Research Center for Medical Sciences, The Jikei University School of Medicine キーワード：数値流体力学 , CFD , 数値構造力学 , CSM , 医工連携 , 3Dプリンター , computational fluid dynamics , computational structural mechanics , medical-engineering collaboration , three-dimensional printer Keyword: 数値流体力学 , CFD , 数値構造力学 , CSM , 医工連携 , 3Dプリンター , computational fluid dynamics , computational structural mechanics , medical-engineering collaboration , three-dimensional printer pp.263-269

発行日 2024年3月10日 Published Date 2024/3/10

DOI https://doi.org/10.11477/mf.1436204910

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Point

・展開後の伸長・短縮を加味したステント留置のシミュレーションができるようになってきている．

・3Dプリンターモデルを使用して，コイル塞栓術アシスト用ステントやフローダイバーター，Woven EndoBridge（WEB）の留置，シャント疾患治療の事前シミュレーションが可能である．

・医工連携とシミュレーションに対する薬事承認や保険収載，そのための適切な事業化が今後の重要課題である．

　With the advent of high-resolution imaging and advancements in computational fluid dynamics（CFD）and computational structural mechanics（CSM）analyses, clinical simulation of endovascular intervention has gradually become feasible. Virtual stents have become indispensable for coil embolization. For braided stents, such as those with low-profile visualized intraluminal support and flow diverters, predicting postplacement elongation and contraction is challenging; however, software development has enabled more precise treatment planning. Additionally, simulations utilizing three-dimensional（3D）printer models can enable realistic simulations of procedures such as intracranial stents and Woven EndoBridge placement. This approach is beneficial for shunt disorders such as arteriovenous malformations and dural arteriovenous fistulas, offering 3D visualization of shunt access routes and intuitive treatment strategy planning, even for beginners. Furthermore, it can be applied to procedures such as open surgical clipping and nidus resection, aiding in the selection of suitable clips and considerations for ideal resection based on nidus curvature. Simulations using CFD, CSM, and 3D printers are crucial for training surgeons and handling new devices. Harnessing medicine-engineering synergy is essential, and regulatory approval（insurance coverage）and appropriate commercialization of simulations are paramount for the future.