鼻窦和鞍区结构三维可视化图像重建及其在经鼻蝶内镜手术中精确定位作用  

Stereotatic image-guided accurately positioning in trans-nasal-sphenoidal endoscopic surgery with three-dimensional visualized image reconstruction of nasal sinuses and sella turcica structure

作　　者：吴文[1] 王亚明[2] 周杰[3] 张剑宁[2] 

机构地区：[1]北京市海淀医院耳鼻喉科,100000 [2]海军总医院神经外科 [3]中国中医科学院望京医院神经外科

出　　处：《中华脑科疾病与康复杂志（电子版）》2011年第2期5-8,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：首都医学发展科研基金(2007-3167)

摘　　要：目的探讨三维可视化图像重建引导对窦腔内微小、变异结构及鞍底的精确定位的可行性。方法对4个成人头颅标本行鼻窦、鞍区CT薄层扫描,对鼻腔内和鞍区重要解剖结构分别进行三维可视化"容积重建",通过多模数据的配准、三维容积图像的融合、拆分,以虚拟现实技术实现对鼻腔内部结构的个体化浏览、显示和精确定位;选取鼻腔内40个靶点结构(蝶窦开口、鞍底等)进行立体定向图像引导的定位,引导内镜到达靶点后实体解剖,测量靶点实际位置和影像定位点之间的距离,误差距离小于5 mm为精确定位。结果鼻腔内部结构的三维容积重建图像效果逼真,空间位置构型真实客观,统计40个靶点的导向,37个靶点位置精确,准确率达92.5%;平均误差3 mm,定位平均准备时间20 min,重要解剖标志蝶窦开口、鞍底、蝶骨平台、视神经-颈内动脉隐窝、视神经管隆突、颈内动脉隆突、斜坡凹陷前缘、筛孔等均能精确定位。结论鼻窦和鞍区解剖结构的三维图像重建,导入路径可视化和虚拟鼻内镜演示,结合立体定向引导技术,能对鼻窦内部结构进行"个体化、直观"的浏览和精确定位,为经鼻蝶内镜手术提供准确性保障。Objective To investigate the feasibility of three-dimensional （3D）visualized image reconstruction guided accurately positioning methods to tiny lesion of sinus cavity and sella turcica bottom or anatomical individual aberrance. Methods Stereotatic frame was installed on 4 adult eranio-cadavers with screws. Thln-slice CT scan acquired spatial localization data of nasal cavity and sella turcica structure. Aero-tech surgerical software assisted three-dimensional visualized ＂volume construction ＂of these structure. Through multi-modal image data match, 3D image fusion and dissection, individually browsing were realized. Forty intra-nasal target-structures （sphenoidal ostium, sellar floor etc） were chosen. Combining stereotaetic and image-guided, exect inserting path were designed to guide nasal endoscope to target region and carry out anatomic observation and measurements. The accurate of image-guided methods were validated （setting distance error 〈 5 mm as exact positioning）. Results The effect of 3D image reconstruction and virtual endoscope were fidelity. Spatial configuration were objective, The accurate rate of image-guided position was 92.5% and target mean error was 3 mm. The pre-operative plan ready average time was 20 minutes. The location of important intranasal structure （ sphenoidal ostium, sellar floor, sphenoid platform, optic nerve-carotid artery recess, optic prominence, carotid artery prominence, clivus umbilication antero- margin, cribriform foramina ect） were accurate under image-guided. Conclusion The 3D image reconstruction guided visual inserting path and virtual endoscopic maneuvering, combining stereotactic guided techinique, provides individual intuitionistie view and accurate position of intranasal structure, also provides the exact assist to trans-nasal-sphenoidal endoscopic surgery.

关 键 词：虚拟现实 可视化 立体定位技术 

分 类 号：R765[医药卫生—耳鼻咽喉科] TP391.41[医药卫生—临床医学]