虚拟现实系统在经枕髁入路显露颈静脉结节三维解剖研究中的应用

目的探讨虚拟现实系统在经枕髁入路显露颈静脉结节三维解剖研究中的应用。方法选取18例尸体头颅作为研究对象,采用头颅MRI和CT扫描,将混合造影剂乳胶依次灌注到静脉系统和动脉系统中,灌注后行2次头颅CT扫描。解剖两侧尸体头颅时根据枕髁入路,切除部分小脑半球显露颅神经和脑干,再次行头颅MRI扫描,将所扫描的影像数据输入虚拟现实系统,根据数据结果构建颈静脉孔区三维解剖模型,设计经枕髁入路显露颈静脉结节的手术路径,可选择颅盖和颅底的骨性标志点,采用相应的测量方式测验结果。比较不同手术路径解剖显露情况、手术解剖测量数据及各解剖结构在手术路径微创前后的变化。结果模拟手术路径直观地体现了神经、血管等随操作方向和角度等解剖结构变化。虚拟现实系统和尸体头颅测量结果一致,但是三维解剖模型数据测量无观察和测量角度限制。三维解剖影像模型显示,微创化后手术路径体积、路径中静脉窦体积及岩骨骨性结构小于微创化前,差异有统计学意义(P0.01);脑神经体积在微创化前后差异无显著性(P0.05)。结论经枕髁入路微创化手术路径在限定靶点的情况下显露解剖结构随之变化,也减少对重要神经血管结构损伤,值得临床推广和应用。

Three-dimensional anatomical study on the occipital condyle approach to the jugular tubercle using virtual reality system

Objective To study three-dimensional anatomy of the occipital condyle approach to the jugular tubercle using virtual reality system. Methods Eighteen cadaveric heads were used for the magnetic resonance imaging (MRI) and head CT scans. The scan image data input into virtual reality system which was used to build three-dimensional anatomical model in jugular hole area, design the occipital condyle approach to jugular tubercle during calvarium and skull base surgery, and analyze bony landmark observation of different surgical measurements reveal and anatomical data in comparison. Results The simulated surgery path reflected the nerves, blood vessels, and anatomical structure change along with the changes of the operating direction and angle. The results of by virtual reality systems were same as consistent body cephalometric, but the three-dimensional anatomical method did not limit about observe and the angle measure. Three dimensional anatomical imaging model showed that the surgical path volume, sinus volume in path and rock bone structure after injury were less than that before injury（P＜0.01）. There was not statistically significant difference of brain volume before and after injury（P＞0.05）. Conclusion Via occipital condyle in the minimally invasive surgery path can under the condition of the limited targets exposed anatomical structure changes, also reduce the important nerve vascular structural damage, worthy of clinical popularization and application.