Kawase入路操作方向对脑干显露影响的虚拟现实解剖学研究  

Anatomic research of minimally invasive surgical route for presigmoidal approach exposing jugular tubercle by virtual reality skill

作　　者：冯旭 钱增辉[2] 汤可 李一鸣[2] 梁径山[2] 刘爱华[2] 

机构地区：[1]厦门医学院基础医学系,福建厦门361023 [2]首都医科大学附属北京天坛医院、北京市神经外科研究所,北京100050 [3]解放军第三0九医院神经外科,北京100091

出　　处：《中国临床解剖学杂志》2017年第4期384-387,共4页Chinese Journal of Clinical Anatomy

基　　金：首都卫生发展科研专项基金(首发2014-4-5073)

摘　　要：目的在虚拟现实建模基础上探讨Kawase入路显微解剖特征。方法 15例尸体头颅CT和MRI影像数据用于构建颅底虚拟现实三维解剖模型。以开颅和磨除岩骨的标志点连线为轴线作出圆柱模拟Kawase入路手术路径。观察和测量两种方向手术路径中解剖结构显露情况。结果 Kawase入路路径1包含岩上窦,路径终点为三叉神经出脑干处的脑桥,包含部分三叉神经和小脑上动脉。路径2包含岩上窦、岩下窦和基底窦,之后于脑桥腹侧依次经过同侧三叉神经、同侧展神经、基底动脉、对侧展神经和对侧三叉神经,路径2终点为路径圆柱轴线与对侧三叉神经根的交点。路径2中所测手术路径、路径中骨性结构、脑干、动脉结构、静脉结构、岩浅大神经和同侧三叉神经体积均大于路径1中所测数据,差异有统计学意义。操作方向1和2路径中包含颞叶体积差异无统计学意义。结论 Kawase三角形成一个手术窗口,改变经过窗口的路径方向时,路径操作范围随之改变。经过颞骨颧突根部上缘的路径更有助于显露脑干腹侧。Objective To discuss the anatomic features of Kawase approach based on virtual reality image model. Methods Image data of CT and MRI scan performed to fifteen adult cadaver heads were used to establish virtual reality three-dimensional anatomy model of skull base. The lines between landmark points of craniotomy and petrous bone drilling were used as axis to outline cylinders simulating surgical routes of Kawase approach. Anatomic exposures in two surgical routes were observed and measured. Results Route 1 of Kawase approach involved superior petrous sinus and the end of route involved pon at the root entry zone of trigeminal nerve. Route 1 involved partial trigeminal nerve and superior cerebellar artery. Route 2 of Kawase approach involved superior petrous sinus, inferior petrous sinus and basal sinus. And then, ipsilateral trigeminal nerve, ipsilateral abducent nerve, basal artery, contralateral abducent nerve and trigeminal nerve were passed through. The end of route 2 was the intersection between axial line of cylinder and the root of contralateral trigeminal nerve. The volumes of route 2 and osseous structures, brainstem, artery, vein, greater superficial petrosal nerve and ipsilateral trigeminal nerve involved were more than those of route 1 with statistical significance. The volume difference of the temporal lobe between the two route did not reach statistical significance. Conclusions Kawase triangle forms a surgical window through which the direction of route will change the operative range. The route which passes through the superior edge at the root of the temporal bone zygomatic process will be helpful to expose the brainstem ventral space.

关 键 词：Kawase入路 虚拟现实 三维解剖 颅底 岩骨 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学] R651.1[医药卫生—基础医学]