远外侧入路显露枕骨大孔前缘的虚拟现实微创化研究  

Minimally invasive design of far lateral approach exposing anterior edge of foramina magnum by virtual reality system

作　　者：钱增辉[1] 陈心玥 苏萍 周小敏 冯旭 汤可 Qian Zenghui;Chen Xinyue;Su Ping;Zhou Xiaomin;Feng Xu;Tang Ke(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Basic Medicine,Xiamen Medical College,Xiamen 361023,China;Department of Traumatic Neurosurgery,P.R.China.Institute of Neurosurgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]厦门医学院临床医学系基础医学部,361023 [3]解放军总医院第一医学中心神经外科医学部颅脑创伤外科,北京100853

出　　处：《神经疾病与精神卫生》2022年第10期700-703,F0003,共5页Journal of Neuroscience and Mental Health

基　　金：首都卫生发展科研专项项目(首发2014-4-5073);机能与临床转化福建省高校重点实验室开放基金资助项目(JNYLC1808)。

摘　　要：目的在虚拟现实三维解剖模型中探讨远外侧入路微创显露枕骨大孔前缘的可能性。方法选取15例(30侧)成人尸体头颅的CT和MRI扫描数据输入虚拟现实系统构建三维解剖模型,选择颅盖和颅底骨性标志点勾勒圆柱形模拟远外侧入路显露枕骨大孔前缘的手术路径。通过缩小圆柱范围进行微创设计,观察和比较微创化前后手术路径中的解剖显露情况。结果微创化前后术后路径不包含乙状窦和颈静脉球,避开小脑半球。微创化前手术路径中包含延髓体积为(143.25±10.15)mm^(3),微创化后手术路径避开延髓。微创化后手术路径以及路径中所包含骨性结构、颅神经和动脉结构的体积小于微创化前手术路径[(2052.70±115.84)mm^(3)比(8346.80±122.98)mm^(3),(1345.40±92.82)mm^(3)比(4291.00±111.81)mm^(3),(1.78±0.10)mm^(3)比(52.23±0.82)mm^(3),(4.12±0.11)mm^(3)比(163.95±9.92)mm^(3)],差异有统计学意义(P<0.01)。结论在明确操作方向的前提下,缩小手术路径范围可以在保证远外侧入路显露枕骨大孔前缘的同时减少手术创伤。Objective To discuss the possibility of the minimally invasive design of far lateral approach exposing foramina magnum based on virtual reality anatomic model.Methods Image data of CT and MRI scans performed to fifteen adult cadaver heads(30 specimens)was inputted into Vitrea virtual reality system to establish three-dimensional anatomy model.Osseous landmark points on the calvaria and skull base were selected to outline cylinder simulating far lateral exposing foramina magnum.Minimally invasive design was made by reduce the size of cylinder.Anatomic exposures before and after design were observed and compared.Results Surgical routes before and after minimally invasive design avoided sigmoid sinus,jugular bulb and cerebellum.The route before minimally invasive design involved medullar with volume of(143.25±10.15)mm^(3).However,the route following design avoid medullar.Comparison showed that volumes of the route,osseous structure,cranial nerve and artery following minimally invasive design were less than those before design[(2052.70±115.84)mm^(3) vs(8346.80±122.98)mm^(3),(1345.40±92.82)mm^(3) vs(4291.00±111.81)mm^(3),(1.78±0.10)mm^(3) vs(52.23±0.82)mm^(3),(4.12±0.11)mm^(3) vs(163.95±9.92)mm^(3)],with statistical significance(P<0.01).Conclusions Under the determined direction,reduction of surgical route size can reduce the injury,meanwhile,ensure exposure of anterior edge of foramina magnum for far lateral approach.

关 键 词：远外侧入路 枕骨大孔 颅底外科 虚拟现实 三维解剖 

分 类 号：R651.1[医药卫生—外科学]