摘要
目的在虚拟现实解剖建模基础上,探讨实现经枕髁显露颈静脉结节的路径微创化可行性。方法 15例尸体头颅CT和MRI数据构建颈静脉孔区三维解剖模型,在颅盖和颅底选择骨性标志点,设计经枕髁显露颈静脉结节的手术路径。观察和测量路径体积改变后解剖结构显露情况。结果手术路径微创化前后均从脑干外侧、小脑半球腹侧和颈静脉球内侧经过。微创化前手术路径依次显露椎动脉、后组脑神经和颈静脉球,在颈静脉球内侧下方显露舌下神经,在后组脑神经上方显露小脑前下动脉。微创化后手术路径从舌咽神经下方穿过,包含部分迷走神经、副神经、舌下神经、小脑前下动脉和岩下窦。测量手术路径、路径中骨性结构、后组脑神经和静脉的体积:微创化前>微创化后,差异均有统计学意义(P<0.05)。微创化前后手术路径中,小脑前下动脉体积差异无统计学意义。结论经枕髁显露颈静脉结节的微创化手术路径能够减少骨性结构磨除以及对后组脑神经和静脉损伤,同时不影响对小脑前下动脉显露。
Objective To explore the feasibility of minimally invasive exposure of the jugular tuberculum through transcondylar approach based on virtual reality anatomic model. Methods CT and MRI data of 15 adult cadaver heads were utilized to establish three-dimensional anatomy model of the jugular foramen region. Surgical routes of exposing the jugular tuberculum via transcondylar approach were simulated by selecting osseous landmark points on the calvaria and skull base. Anatomic exposures were observed and measured following volume changes of surgical routes. Results Surgical route before and after minimally invasive design passed the lateral to the brainstem, ventral to the cerebellum and medial to the jugular bulb. Surgical route before minimally invasive design exposed the vertebral artery, lower cranial nerve and jugular bulb in turn. Then, hypoglossal nerve could be exposed medial and inferior to the jugular bulb. Anterior inferior cerebellar artery was exposed superior to the lower cranial nerve. Surgical route after minimally invasive design passed below the glossopharyngeal nerve, and then, displayed partial vagus nerve, accessory nerve, hypoglossal nerve, anterior inferior artery and inferior petrous sinus. Volumes of surgical route and osseous structures, lower cranial nerve and vein in the route before minimally invasive design were more than those after minimally invasive design, with statistical significance （P 〈 0.05）. Comparison showed no statistically significant difference in the volume of anterior cerebellar artery in the route between before and after minimally invasive design. Conclusions Bone drilling and injury to the lower cranial nerve and vein can be reduced in the minimally invasive surgery via transcondylar approach for exposingthe jugular tuberculum. Meanwhile, the exposure of the anterior inferior cerebellar artery is not impacted by minimally invasive design.
出处
《中国微侵袭神经外科杂志》
CAS
2016年第8期361-363,共3页
Chinese Journal of Minimally Invasive Neurosurgery
基金
首都卫生发展科研专项基金(编号:2014-4-5073)
关键词
虚拟现实
颈静脉结节
枕髁
三维解剖
微创
virtual reality
jugulare tubercula
occipital condyle
three-dimensional anatomy
minimal invasion
