摘要
目的在构建虚拟现实解剖模型基础上探讨枕下乙状窦后入路微创显露颈静脉孔区的显微解剖特征。方法15例尸体头颅行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建颈静脉孔区三维解剖模型,在颅盖和颅底中选择骨性标志点设计枕下乙状窦后入路的不同微创路径,观察测量和比较伴随微创手术路径改变后解剖结构显露情况。结果模拟枕下乙状窦后入路显露颈静脉孔区的路径均由横窦下方穿过,路径中清晰显示所包含的神经、血管等解剖结构的空间层叠顺序,均不包含椎动脉和小脑后下动脉。路径a中不包含后组颅神经。路径b均不显露面听神经复合体,3例路径b中不显露小脑前下动脉。路径c不显露面听神经复合体、小脑前下动脉和后组颅神经。测量和比较显示手术路径体积和路径中小脑半球体积:路径b>路径a>路径c,路径中显露小脑前下动脉的体积:路径a>路径b,差异均有统计学意义(P<0.01)。结论枕下乙状窦后入路的不同微创化手术路径能够有效显露颈静脉孔区的不同靶点,联合使用能够充分发挥各自的优势。
Objective To discuss microanatomy features of jugular foramen region in suboccipitoretrosigmoidal minimally invasive approach based on virtual reality image model.Methods CT and MRI scaning were performed for 15 adult cadaver heads,and then the image data was inputted into Vitrea virtual reality system to establish three-dimensional anatomy model of jugular foramen region.Different minimally invasive suboccipito-retrosigmoidal approaches were simulated by selecting osseous landmark points on the calvaria and skull base.Anatomic exposures in surgical trajectory following alternation of minimally invasive approach were observed,measured and compared.Results Routes simulating suboccipito-retrosigmoidal approach for exposure of jugular foramen region passed under the inferior edge of transverse sinus.Spatial sequence of nerves and vessels in the route was displayed clearly.Vertebral artery and posterior inferior cerebellar artery did not show in the route.Lower cranial nerves did not show in route a.Facial-acoustic nerve complex did not show in route b.Three cases of route b did not involve anterior inferior cerebellar artery.Facial-acoustic nerve complex,anterior inferior cerebellar artery,and lower cranial nerves did not show in route c.Measurement and comparative analysis showed that：the volume of route and cerebella involved in route,route b route a route c（P 0.01）;and the volumes of anterior inferior cerebellar artery in route,route a route b（P 0.01）.Conclusion Different minimally invasive routes of suboccipito-retrosigmoidal approach can expose surgical targets effectively,and their combinations have more advantages.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2014年第14期1496-1499,共4页
Journal of Third Military Medical University
基金
解放军309医院院立课题(2013MS-008)~~
关键词
颈静脉孔
虚拟现实
三维解剖
乙状窦后入路
微创
jugular foramen
virtual reality
three-dimensional anatomy
retrosigmoidal approach
minimal invasion
