神经内镜经蝶手术三维可透视化模型的构建及术前规划作用的研究  

Construction of three-dimensional perspective model of endoscopic transsphenoidal surgery and the role in surgical planning

作　　者：武晓瑛[1] 汤敏[2] 缪星宇[3] 

机构地区：[1]陕西省人民医院骨科 [2]陕西省人民医院影像科 [3]陕西省人民医院神经外科,陕西西安710068

出　　处：《川北医学院学报》2015年第4期488-490,505,共4页Journal of North Sichuan Medical College

基　　金：陕西省科学技术研究发展计划项目(2013K12-20-13)

摘　　要：目的:采用虚拟现实技术构建内镜经蝶手术三维可透视化模型,并探讨其在神经内镜下经蝶鞍区手术规划中的应用价值。方法:选取36例经MRI诊断为鞍区肿瘤的患者,术前收集薄层CT、MRI、MRA资料,采用Vitreafx影像学数据工作站构建蝶鞍区三维可透视化模型,观测解剖结构相关入路标志及与肿瘤的空间位置关系,模拟手术操作,并与神经内镜下实际手术过程进行对比。结果:所有患者建立的三维可透视化模型均显示出清晰的解剖定位标志,即蝶鞍区骨质、蝶窦间隔、颈内动脉隆突、视神经隆突、视神经、肿瘤等及与肿瘤毗邻关系;手术规划方案及手术入路成功制定,术前模拟与术中实际情况一致。结论:所建三维可透视化模型较真实,可为术者提供清晰的立体解剖信息,为手术前期的规划提供有效帮助;术前模拟手术入路方式,可减少实际术中风险,提高手术精确性和安全性。Objective：Virtual reality technology was applied to build three-dimensional perspective model of transsphenoidal surgery to explore the role in application value in endoscopic transsphenoidal surgical planning. Methods：A total of 36 patients with sellar tumor diagnosed by MRI were included in the study. The CT,MRI,MRA data of each patient was collected preoperatively. Then Vitreafx Imaging Data Workstations was used to bulid the three-dimensional perspective model of sellar region. Anatomical structures re-lated to surgical approach and spatial positional relationships with tumor were observed and surgical procedure was simulated. Finally the simulated endoscopic operation and actual endoscopic surgery process was compared. Results：Three-dimensional perspective model of each patient was established sucessfully and the anatomic location like bone,sphenoid sinus interval,cervical internal carotid arterial eminence,bulges of optic nerve canal,optic nerve and tumors as well as the adjacent relationships of markers with tumors were clearly displayed. Surgical planning and surgical approach were formulated successfully,and the actual endoscopic surgery process was consist-ent with the simulated endoscopic operation. Conclusion：Three-dimensional perspective model has high authenticity and it provides a clear three-dimensional anatomical information and effective assistance to the pre-surgery planning. The simulated endoscopic operation under the guidance of three-dimensional perspective model before surgery can reduce risks of surgery and improve surgical accuracy and safety.

关 键 词：鞍区肿瘤 神经内镜 三维可透视化模型 手术规划 

分 类 号：R473.7[医药卫生—护理学]