虚拟现实技术评估远外侧入路显露下斜坡的显微解剖特征

摘要

目的 通过虚拟现实系统构建远外侧入路显露下斜坡的三维解剖模型,比较显露靶点对显微解剖所产生的影响.方法 对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后窝三维解剖模型,选择颅盖和颅底骨性标志点,勾勒远外侧入路显露下斜坡不同靶点的手术路径,以显露同侧颈静脉结节前缘为路径a,显露对侧颈静脉结节前缘为路径b,显露枕骨大孔前缘为路径c.观察、测量和比较3个手术路径的显微解剖差异.结果 远外侧入路的3个手术路径经过枕髁后缘、枕骨大孔上方和外侧、脑干外侧、小脑半球腹侧、颈静脉球内侧和副神经下缘,到达显露终点.手术路径和路径中包含脑神经、动脉体积比较显示:路径b＞路径a＞路径c;路径中经过骨性结构体积比较结果显示:路径a＞路径c＞路径b,差异均有统计学意义(P＜0.05).结论 模拟手术路径有助于量化比较远外侧入路显露下斜坡时不同操作方向对手术解剖特征造成的影响.%Objective To establish the three-dimensional anatomical model of the inferior clivus via the far lateral approach by virtual reality system,and compare the impact of different target points on microanatomy.Methods CT and MRI scannings were performed in 15 adult cadaver heads.Image data was inputted into virtual reality system to establish three-dimensional anatomical model of the posterior cranial fossa.Far lateral approaches exposing different target points of the inferior clivus were outlined by selecting osseous landmarks on the calvaria and skull base.The anterior border of the ipsilateral jugular tubercle was revealed as route a,the anterior border of the heterolateral jugular tubercle as route b,and the anterior border of the foramen magnum as route c.The different microsurgical anatomic exposures of the 3 routes were observed,measured and compared.Results The three surgical routes via the far lateral approach passed through the posterior edge of the occipital condyle,upper part of the foramen magnum,lateral side of the brainstem,ventral side of the cerebellum,inside of the jugular bulb,and inferior edge of the accessory nerve,and reached the targets.Comparisons of the volume of the route,cranial nerve and artery showed:route b ＞ route a ＞ route c.Comparisons of the volume of osseous structures showed:route a＞ route c＞ route b.All the results reached statistical significance (P ＜ 0.05).Conclusion Simulative surgical route is beneficial to quantitatively compare the impact of operative directions on the anatomic characteristics of the far lateral approach in exposing the inferior clivus.