面神经隐窝径路手术剖面观察及多层螺旋CT双斜矢状位多平面重建  

Reconstruction of the main sections of the facial nerve recess approach using double oblique multi-planer in multi-slice CT

作　　者：李志海[1] 沈剑敏[2] 吕静瑶[1] 蔡志毅[1] 温西[2] 夏贤武[2] 林叶青[2] 

机构地区：[1]浙江省台州市立医院耳鼻咽喉科 [2]浙江省台州市立医院影像科,浙江台州318000

出　　处：《解剖学报》2012年第1期77-82,共6页Acta Anatomica Sinica

摘　　要：目的通过显微解剖观察面神经隐窝径路手术中涉及到的关键手术剖面及解剖标志,利用多层螺旋CT双斜矢状位多平面重建技术,探讨面神经隐窝径路关键手术剖面主要解剖标志同层显示的可行性及意义。方法在尸体头颅标本上模拟面神经隐窝手术径路,观察手术中涉及到的关键手术剖面及解剖标志。利用多层螺旋CT双斜矢状位多平面重建技术,对80例患者进行面神经隐窝径路中关键手术剖面重建观察,其中成人55例(110耳),儿童25例(50耳),对4个不同方位图像(横断位、冠状位、矢状位及双斜矢状位)同层显示解剖标志的程度进行分级评价。对重要解剖标志与周围重要结构的距离进行影像学测量,比较不同年龄组的测量值有无差异。结果面神经隐窝入路手术中涉及到4层关键手术剖面,其方位均为双斜矢状位。4层关键手术剖面双斜位多平面重建图像中主要解剖标志同层显示程度均优于横断位、冠状位及矢状位,同层显示成功率均为100%。水平半规管上缘中点与中颅窝脑板的垂直距离、乙状窦最前缘与外耳道后壁前缘的垂直距离在不同年龄组间的差异有统计学意义(P<0.05),儿童小于成人。面神经水平段下缘与前庭窗下缘之间的垂直距离及乳突段前缘与圆窗龛后外缘之间的垂直距离在不同年龄组间的差异无统计学意义(P>0.05)。结论多层螺旋CT双斜矢状位多平面重建技术可清晰同层显示面神经隐窝径路手术剖面相关解剖标志,结合手术入路及手术目的,有针对性地进行手术剖面双斜位多平面重建及测量,能为术者提供更有实用价值的影像学信息。Objective To reconstruct the main sections of the facial nerve recess approach using double oblique multi-planer in multi-slice CT. Methods According to the normal surgical procedure of facial nerve recess approach, the temporal bone was dissected to expose main operative sections and anatomic marks. Images of the main operative sections from 80 patients （55 adults and 25 children） without abnormality in the temporal bone were reconstructed using double oblique muttiplaner reconstruction in muilti-slice CT. The achievement ratio was calculated. The differences among the transverse, coronal, and sagittal planes and double oblique planes were compared. The relationship with adjacent structures was measured. The appearances in different images and age groups were compared. Results Four key operative sections were involved in the facial nerve recess approach and their orientations were of oblique sagittal. Landmarks of the four key operative sections displayed on the double-oblique imaging rather than on transverse, coronal and sagittal planes. The achievement ratio of every section was 100%. The vertical distance between the central point of superior margin of horizontal semicircular canal and the bony wall of the middle cranial fossa in children was shorter than that in adults （P 〈 0.05）. The vertical distance between the sigmoid sinus and posterior wall of the external auditory canal in children was shorter than that in adults （P 〈 0. 05）. No significant difference in the distance between the inferior border of the tympanic segment and the inferior margin of the oval window was found between the age groups （P 〉 0. 05）. The vertical distance between the anterior margin of the mastoid segment and posterior external border of round window was not statistically different between the age groups （ P 〉 0. 05 ）. Conclusion Double oblique multi-planar refl^rmation is a new method to demonstrate landmarks of operative sections of the facial nerve recess approach in one slice. In combination with

关 键 词：面神经隐窝 手术入路 多层螺旋CT 多平面重建 人 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]