虚拟现实技术在乙状窦后入路显露斜坡中部微创手术路径研究的应用  

Application of virtual reality technology in minimally invasive route of exposing middle segment of the clivus via retrosigmoidal approach

作　　者：周青[1] 汤可[1] 谢金娟[1] Zhou Qing, Tang Ke, Xie Jinjuan(Department of Neurosurgery, the 309th Hospital of PLA, Beijing 100091, Chin)

机构地区：[1]解放军309医院神经外科,北京100091

出　　处：《中国微侵袭神经外科杂志》2018年第3期131-133,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都卫生发展科研专项基金项目(编号:2014-4-5073)

摘　　要：目的在虚拟现实三维解剖模型中探讨乙状窦后入路微创显露斜坡中部的可行性。方法将15例尸体头颅进行CT和MRI扫描,数据输入虚拟现实系统构建颅底三维解剖模型,选择颅盖和颅底骨性标志点分别勾勒圆柱模拟乙状窦后入路显露斜坡中部的手术路径。缩小圆柱直径进行手术路径微创设计,观察、测量和比较微创化前后手术路径中的解剖差异。结果乙状窦后入路在横窦下方、乙状窦后开颅,到达斜坡中部时,微创化前手术路径包含骨性结构、动脉结构、小脑、脑干和脑神经的体积明显多于微创化后手术路径,差异显著(P<0.01)。微创化后手术路径不包含岩下窦和颅底骨质。结论虚拟现实技术有助于量化比较微创设计的显微解剖特征。在乙状窦后入路显露斜坡中部时,微创化后手术路径有助于减少对神经、血管的牵拉损伤。Objective To explore the practicability of minimally invasive design exposing middle segment of the clivus via retrosigmoidal approach based on virtual reality anatomic model. Methods CT and MRI scans were performed for 15 adult cadaver heads, and the image was inputted into virtual reality system to establish three-dimensional anatomical model of skull base. Surgical route of retrosigmoidal approach exposing middle segment of the clivus was simulated by outlining cylinder based on osseous landmark points on the calvaria and skull base. The diameter of cylinder was rescaled to make minimally invasive design. Anatomic difference of pre-design versus post-design was observed, measured and compared. Results Retrosigmoidal approach passed the inferior to the transverse sinus and the posterior to the sigmoid sinus. When arriving at the middle segment of the clivus, the volumes of osseous structures, artery, cerebellum, brainstem, and cranial nerve involved in the route were larger before minimally invasive design than following the design. All above differences reached statistical significance（P 〈 0.01）. The route following design avoided the inferior petrosal sinus and osseous structures in the skull base. Conclusions Virtual reality technology can be used to make quantitative comparison of micro-anatomic features for minimally invasive design. The route following minimally invasive design in exposing the middle segment of the clivus via retrosigmoidal approach is helpful for reducing stretch injury of neurovascular structures.

关 键 词：入路 乙状窦后 斜坡 技术 虚拟现实 神经解剖学 

分 类 号：R651[医药卫生—外科学]