三叉神经微血管减压术的虚拟现实微创解剖研究  

Minimally invasive anatomic research of microvascular decompression for trigeminal nerve utilizing virtual reality technique

作　　者：周青[1] 汤可[1] 谢金娟[1] 周敬安[1] 

机构地区：[1]解放军第三○九医院神经外科,北京100091

出　　处：《中华神经医学杂志》2015年第10期1027-1030,共4页Chinese Journal of Neuromedicine

基　　金：首都卫生发展科研专项基金（首发2014-4-5073）

摘　　要：目的在构建虚拟现实解剖模型基础上探讨三叉神经微血管减压术微创化过程中的显微解剖特征。方法对5例成人尸体头颅行头颅CT和MRJ扫描，影像数据输入虚拟现实系统构建桥脑小脑角三维解剖模型，设计枕下乙状窦后入路路径，在三叉神经脑池段分别选择三叉神经入脑干处（a点）、人半月神经节处（b点）以及两者之间中点（c点）为显露靶点。分别以上述a、b、c3个显露靶点为顶点做出圆锥a、b、c，模拟枕下乙状窦后入路显露三叉神经脑池段的3个手术路径，观察和测量这3个路径微创化前后解剖结构显露情况并进行统计比较。结果模拟枕下乙状窦后入路三叉神经微血管减压术的路径均由横窦下方穿过，路径清晰显示与周围神经、血管的关系。微创化前后a、b、c3个手术路径的测量数据比较结果为：b路径体积〉c路径体积〉a路径体积，a小脑半球体积〉c小脑半球体积：〉b小脑半球体积。结论枕下乙状窦后入路微创化手术路径能够在保证三叉神经微血管减压术解剖显露的情况下减少手术创伤。Objective To discuss the mieroanatomy features of microvascular decompression for trigeminal nerve through minimally invasive approach based on virtual reality image models. Methods CT and MR/scans were performed to five adult cadaver heads, and then, image data were inputted into vitrea virtual reality system to establish three-dimensional anatomy models of cerebellopontine angle. Suboecipito-retrosigmoidal approach was simulated by selecting asterion as osseous landmark points of craniotomy and cistern segment of trigeminal nerve as exposed target. Anatomic exposures in surgical trajectory were observed and measured before and after minimally invasive design, respectively. Results Routes simulating microvascular decompression for trigeminal nerve through suboccipito-retrosigmoidal approach passed under the inferior edge of transverse sinus. Spacial relationship among route and surrounding nerves and vessels were displayed clearly. Measurement and comparative analysis among different routes indicated the volumes of routes： route b 〉 route c 〉 route a, and involved cerebellar volumes： route a 〉route c 〉 route b. Conclusion Minimally invasive routes of suboccipito-retrosigrnoidal approach can reduce surgical injure without sacrifice of anatomic exposure in microvascular decompression for trigeminal nerve.

关 键 词：三叉神经痛 微血管减压术 虚拟现实 三维解剖 微创 

分 类 号：R651.3[医药卫生—外科学]