枕下乙状窦后入路微创显露颈静脉孔区的虚拟现实解剖研究

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1、4枕下乙状窦后入路微创显露颈静脉孔区的虚拟现实解剖研究编号201311252刊用形式论著汤可，周敬安，赵亚群，周青，刘策(100091北京，解放军第309医院神经外科)［提要］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

2、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

3、。［关键词］颈静脉孔；虚拟现实；三维解剖；乙状窦后入路；微创［中图法分类号］R322.81;R329.28;R743.31［文献标识码］AAnatomicresearchofsuboccipito-retrosigmoidalapproachforminimallyinvasiveexposureofjugularforamenregionutilizingvirtualrealitytechnologyTangKe,ZhouJingan,ZhaoYaqun,ZhouQing,LiuCe(Departmen

4、tofNeurosurgery,The309thHospitalofPLA,Beijing100091,China)[Abstract]ObjectiveTodiscussmicroanatomyfeaturesofjugularforamenregioninsuboccipito-retrosigmoidalminimallyinvasiveapproachbasedonvirtualrealityimagemodel.MethodsCTandMRIscanswereperformedforfifteen

5、adultcadaverheads,andthentheimagedatawasinputtedintoVitreavirtualrealitysystemtoestablishthree-dimensionalanatomymodelofjugularforamenregion.Differentminimallyinvasivesuboccipito-retrosigmoidalapproachesweresimulatedbyselectingosseouslandmarkpointsonthecal

6、variaandskullbase.Anatomicexposuresinsurgicaltrajectoryfollowingalternationofminimallyinvasiveapproachwereobserved,measuredandcompared.ResultsRoutessimulatingsuboccipito-retrosigmoidalapproachforexposureofjugularforamenregionpassedundertheinferioredgeoftra

7、nsversesinus.Spatialsequenceofnervesandvesselsintheroutewasdisplayedclearly.Vertebralarteryandposteriorinferiorcerebellararterydidnotshowintheroute.Lowercranialnervesdidnotshowinroutea.Facial-acousticnervecomplexdidnotshowinrouteb.Threecasesofroutebdidnoti

8、nvolveanteriorinferiorcerebellarartery.Facial-acousticnervecomplex,anteriorinferiorcerebellarartery,andlowercranialnervesdidnotshowinroutec.Measurementandcomparativeanalysisshowedthat:thevolumeofrouteandcereb