CTV与颅骨CT三维重建融合影像在小脑桥脑角肿瘤经乙状窦后入路手术中的运用  

Application of fusion images of CT venography and skull 3D CT reconstruction in microsurgery through retrosigmoid sinus approach for patients with cerebellopontine angle tumor

作　　者：陆波 莫永彪 陈刚[1] 龙飞[1] 唐雄伟[1] 吴军[1] 沈国洪 谢延风[3] LU Bo;MO Yong-biao;CHEN Gang;LONG Fei;TANG Xiong-wei;WU Jun;SHEN Guo-hong;XIE Yan-feng(Department of Neurosurgery,Chongqing Hechuan District People's Hospital,Chongqing 401520,China;Department of Radiology,Chongqing Hechuan District People's Hospital,Chongqing 401520,China;Department of Neurosurgery,The First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆市合川区人民医院神经外科,401520 [2]重庆市合川区人民医院放射科,401520 [3]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《中国临床神经外科杂志》2021年第7期524-526,共3页Chinese Journal of Clinical Neurosurgery

基　　金：重庆市合川区科学技术委员会基金资助项目(HCKW-2017-45);重庆市卫生计生委医学科研项目(2017ZBXM032)。

摘　　要：目的探讨CT静脉成像(CTV)与颅骨CT三维重建融合影像在小脑桥脑角(CPA)肿瘤经乙状窦后入路手术中的指导作用。方法回顾性分析2016年1月至2019年6月经乙状窦后入路手术治疗的36例CPA肿瘤的临床资料。术前应用容积再现技术将CTV与颅骨CT三维重建影像融合,明确横窦、乙状窦与颅骨标志(星点)的位置关系,确定横窦-乙状窦交界处在颅骨表面投影并设置"关键孔",指导开颅手术。结果"关键孔"位于星点正下方或内下方,星点到"关键孔"正下方垂直距离在7~21mm,平均(12.8±3.8)mm;星点到"关键孔"水平距离在0~9 mm,平均(3.6±2.5)mm。术中清晰暴露横窦-乙状窦交界处,均无静脉窦损伤。术中骨瓣一次成型,用时平均38 min,视野充分暴露,显微镜下全切除肿瘤,术后无明显骨质缺损,无皮下积液、切口脑脊液漏、颅内感染,乳突积液等并发症,均恢复良好。结论CPA肿瘤经乙状窦后入路手术中,CTV与颅骨CT三维重建融合影像对手术有一定指导意义,有利于静脉窦保护,且操作简单高效。Objective To investigate the clinical value of fusion images of CT venography(CTV)and skull 3 D CT reconstruction in microsurgery through retrosigmoid sinus(RSS)approach for the patients with cerebellopontine angle(CPA)tumor.Methods The clinical data of 36 patients with CPA tumor who underwent microsurgery through RSS approach from January 2016 to June 2019 were analyzed retrospectively.The fusion images,which were obtained using CTV data and skull 3 D CT reconstruction images by volume rendering technique,were used to define the location relationship between the transverse sinus,sigmoid sinus and the skull markers(star point),and determine the transverse-sigmoid sinus junction on the skull surface and then set a"key hole"in order to guide the craniotomy.Results"Key hole"was located directly below the star point.The vertical distance between the star point and"key hole"ranged from 7 to 21 mm,with an average of(12.8±3.8)mm.The horizontal distance between the star point and"key hole"ranged from 0 to 9 mm,with an average of(3.6±2.5)mm.The sinus junction of the transverse sinus and sigmoid sinus was clearly exposed without intravenous sinus injury.The intraoperative bone flap was molded once with an average time of 38 min.The surgical field-of-view was fully exposed,and total resection of tumors was achieved in all the patients without complications such as obvious bone defect,subcutaneous effusion,cerebrospinal fluid leakage,intracranial infection,and processus mastoideus effusion.All the patients were recovered well.Conclusions For patients with CPA tumor undergoing surgery through RSS approach,the use of CTV combined with cranial bone surface markers has certain guiding significance,which is advantageous for intravine protection,and is simple and efficient.

关 键 词：小脑桥脑角肿瘤 显微手术 枕下乙状窦后入路 CT静脉成像 颅骨标志 星点 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]