面神经隐窝手术解剖三维模拟

目的：利用计算机重建技术模拟面神经隐窝入路手术三维解剖。方法：取新鲜颞骨标本块，不脱钙聚合物包埋，骨切片机连续薄切片，经扫描、图像处理、精确对位后，提取颞骨内各结构轮廓，重建三维图像。结果：重建图像细致精确，较完整地反映了面神经隐窝手术解剖。结论：面神经隐窝手术解剖的三维模拟能提供颞骨结构立体图像，直观反映各结构之间复杂的空间毗邻关系，可用于手术设计和手术前训练。     

后壶腹神经的解剖观察

<正> 选择性地进行后壶腹神经切断术,治疗良性头位性眩晕取得了较好的效果。而有关后壶腹神经的解剖研究很少。为了使临床手术迅速准确地找到这一神经,减少并发症,本文研究了25具颞骨标本后壶腹神经在圆窗龛底解剖位置的变     

基于虚拟中国人数据集的鼻部及颞骨解剖结构三维重建

目的：为可视化虚拟人体模型鼻部及颞骨解剖结构的三维重建探索一种可行的方法。方法：利用3D-Slicer软件进行鼻部及颞骨部分解剖结构的三维重建。对单层图片进行图象分割及提取，处理后的体数据导入3D—Slicer，选择阈值进行进一步的图像分割，产生感兴趣区的标志图，进而重建出组织结构的三维表面模型。结果：成功重建了四组鼻窦，鼻中隔，中下鼻甲，颞骨，鼓室，乳突气房，乙状窦，颈内动脉的三维表面模型，并可显示不同结构间的毗邻关系与空间定位。结论：基于中国第一号虚拟人数据集，用3—D软件可以实现鼻部颞骨部分解剖结构三维可视化，便于对该部解剖结构的观察和理解。     

中国人侧颅底区可视化研究

目的建立中国人体侧颅底区局部可视化数字模型，为该区疾病的影像学诊断及外科手术治疗提供数字形态学依据。方法应用我室建立的数字化可视人体数据集，采用体绘制及面绘制重建方法，分别在P4微机和SGI工作站上对侧颅底区重要结构进行计算机三维重建及立体显示。结果侧颅底区局部可视化数字模型能够清晰显示侧颅底各重要结构。本研究着重显示了侧颅底神经血管区、颞骨内结构、颈内动脉及其毗邻结构与侧颅底骨性组织的三维解剖关系。三维重建结构可以单独或联合显示，重建结构的任意径线及角度均可进行适时三维测量。结论我室建立的数字化可视人体数据集能够较好地重建侧颅底区可视化解剖模型，反映该区域重要解剖结构及其空间毗邻关系，该结果可应用于侧颅底外科手术辅助教学以及手术入路的辅助设计等。     

扩大颅中窝硬脑膜外经颞骨岩部入路至岩斜区的应用解剖

目的：研究中窝硬膜脑膜外经颞骨岩部入路进行岩斜区直接手术的手术方法，并提供相应的解剖依据。方法：用15例成人尸体头部标本模型颅中窝硬脑膜外经颞骨岩部入路进入岩斜区及其邻近结构的显露和解剖。结果：（1）岩大神经是磨除颞骨岩部十分重要的标志，通过它可以定位岩部颈内动脉、耳蜗和膝状神经节；（2）颅中窝硬脑膜外经颞骨岩部入路可以充分暴露从鞍背到桥延沟的岩斜区。结论：（1）以岩大神经为标志磨除颞骨岩部为安全手术提供了保证；（2）此入路具有暴露好，神经血管损伤的特点，特别适用于骑跨中，后窝的岩斜区病变。     

面神经隐窝进路的相关解剖研究

目的：对面神经隐窝进路涉及解剖区域的相关显微解剖和影像学解剖的研究进展进行综述。方法：选用近几年关键词为“面神经”、“颞骨”及“后鼓室”的文章进行分析和总结。结果：其解剖结构复杂精细,涉及面神经乳突段、鼓索神经、砧骨窝之间的解剖区域。一些重要解剖结构的位置相对恒定,如锥隆起、圆窗龛、圆窗、前庭窗、镫骨、砧骨短脚、匙突、面神经鼓室段、水平半规管凸、后半规管凸等,可以作为手术的参考标记。结论：面神经隐窝进路在现代耳显微外科中有重要地位,熟悉其解剖关系,可以指导临床手术,避免损伤。     

颞骨的三维重建及其临床应用进展

随着耳神经外科和侧颅底手术的开展,颞骨的精确解剖结构空间关系日益显示出其重要性。颞骨内结构多、体积小、毗邻关系复杂,常规解剖及单纯切片研究仍不能满足临床需要。近年来,运用计算机三维重建技术研究颞骨已取得了较大进展。在临床应用方面,三维影像技术应用于耳和颞骨疾病诊断的进展迅速,耳科和颞骨的计算机辅助外科研究也已开展起来。     

颞骨内部结构三维重建及临床应用

随着耳显微外科及侧颅底手术的广泛开展，颞骨的精确解剖结构空间关系日益显示出其重要性。颞骨内部结构复杂、体积小、毗邻关系复杂，常规解剖及单纯切片研究均不能很好地说明它们的空间细节及空间测量的精确性。近年来，应用计算机三维重建研究颞骨，已使颞骨研究从定性向定量发展，极大地促进了耳科及相关学科的发展。     

颞骨内面神经垂直段的显微解剖及其临床意义

目的：研究颞骨内面神经垂直段及其毗邻结构的显微解剖,为临床应用提供解剖学资料。方法：通过模拟临床经乳突入路的方法,分层解剖20个成人湿性头颅标本（40侧颞骨）,显露并观测颞骨内面神经垂直段及其毗邻结构。结果：面神经垂直段的长度为（17.39±1.78）mm、直径为（2.13±0.13）mm,面神经垂直段与水平段的夹角（向前）为（115.5±6.89）°,面神经垂直段近端至外半规管隆突距离为（2.86±0.31）mm,鼓索神经自面神经发出点至茎乳孔距离为（5.99±0.74）mm,面神经垂直段与鼓索神经的夹角（向上）为（38.6±1.99）°,锥隆起尖到面神经垂直段垂直距离为（2.05±0.65）mm,后半规管至面神经垂直段最短距离为（2.89±0.36）mm。有5%（2/40侧）的面神经垂直段的近端位于外半规管隆突外侧。结论：外半规管、鼓索神经、茎乳孔、锥隆起、后半规管是手术中确定面神经垂直段的重要标志。熟悉颞骨内面神经垂直段与其周围结构的毗邻关系,有利于面神经垂直段相关手术的顺利进行。     

计算机辅助模拟耳科乳突根治术的实验研究

目的：通过CT三维重建从影像学的角度探讨颞骨内部特殊结构的形态学特征及采用计算机辅助模拟手术的可能性。方法：6人（12侧）应用GE Hispeed CT/i，按照合适的螺旋扫描参数对面神经、内听道、耳蜗、半规管、乙状窦、后颅窝底板和颈静脉窝结构进行三维重建，将重建的结构还原于颅骨的位置，用计算机辅助进行模拟乳突根治手术。结果：重建的组织结构精确、形象、直观。进行乳突根治的模拟手术，步骤明确，与常规的手术有极相似特性。结论：应用计算机辅助的CT三维结构重建并进行模拟手术，对制定耳科手术计划有重要的意义。     

Preliminary study on digitized nasal and temporal bone anatomy

The purpose of this study was to explore a feasible method for the reconstruction of the nasal and temporal bone structures of the Chinese virtual human project and provide a more accurate and facilitated way view them three-dimensionally (3D). The 3-D Slicer software was used to reconstruct the anatomic structures of the human nose and temporal bone. Segmentation and extraction of the contours of the ROI (region of interest) in each single slice were conducted and the processed volume data was transferred into the 3-D Slicer. After resegmentation, a set of labeled maps of the ROI were produced. Based on these maps, the 3D surface models of the tissues of interest were constructed. Four groups of paranasal sinuses, nasal septa, middle and inferior turbinates, temporal bones, tympanic cavities, mastoid air cells, sigmoid sinuses, and internal carotid arteries were reconstructed successfully. These models show spatial relationships and orientation between them. The results show that the 3-D Slicer may be used for the 3D visualization of parts of anatomic structures in the nose and temporal bone based on the first Chinese virtual human data, and thus, can facilitate the observation and understanding of the anatomic structures in this area.     

Plastination and computerized 3D reconstruction of the temporal bone

The purpose of this study was to generate a computerized 3D reconstruction of the temporal bone and intratemporal structures. A plastination technique was used to obtain equidistant serial thin sections of 1.2 mm thickness and, on an SGI workstation, a Contour-Marching Cubes algorithm was selected to reconstruct the temporal bone and intratemporal structures in three dimensions. All reconstructed structures can be represented individually or jointly and rotated in any plane. Any diameter and angle of a structure can be conveniently measured. The capability of reconstructing individual and combined images of intratemporal structures, viewing them from all surgical angles, and accurately measuring their spatial relationships gives skull base and otologic surgeons important guidance. The reconstructed model can also be used for resident education, rehearsal of an unfamiliar surgery, and for developing a new surgical approach.     

Three-dimensional imaging of the petrous bone for the middle fossa approach to the internal acoustic meatus: an experimental study

The goal of this study was to highlight the feasibility of creating three-dimensional (3D) pictures of the petrous bone from a routine CT examination which can be used for a middle fossa approach to the internal acoustic meatus, in order to secure this operation. The surgical aim is to reach the roof of the internal acoustic meatus directly without injuring the adjacent functional structures of the petrous bone. Two heads of embalmed cadavers were scanned every millimeter with a slice thickness of 1 mm centered on the petrous bones. The horizontal reference was the Frankfurt line and the frontal and sagittal planes were perpendicular to this line. This method is similar to routine examinations for surgical patients. The pictures were first loaded on an optical disk, then into a computer (Silicon Graphics System). Amira software was used to create 3D pictures. The anatomy of the temporal bone could easily be identified, notably the surgical landmarks of the middle fossa approach. Three-dimensional computer-assisted imaging can reveal the anatomy of the petrous bone in a realistic view. The main anatomic structures for a middle fossa approach can be recognized easily. This realistic view may be very useful for surgeons, and 3D images deserve to be developed further.     

Surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation based on three-dimensional reconstructed temporal bone CT images

Purpose

In this study, we evaluated the surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation (CI).

Materials and methods

Twenty computed tomography (CT) images of the temporal bone from patients aged between 20 and 60 years were selected. The inclusion criterion was a radiologically normal temporal bone CT scan. Three-dimensional (3D) reconstructed images were obtained using high-resolution axial temporal bone CT scans. Eight points were used to evaluate the surgical anatomy of the posterior tympanotomy and cochleostomy. The length of lines between the points and the angles between the lines were measured.

Results

The mean length of line AB (superior-inferior length of the posterior tympanotomy for CI) was 6.48 ± 0.26 mm, while line AC (width of the chorda tympani and facial nerves) was 3.60 ± 0.2 mm. The mean angle of ABC (angle at which the chorda tympani nerve branched from the facial nerve) was 18.40° ± 1.05°. The mean length of line AD (distance from the facial ridge to the point of cochleostomy) was 9.58 ± 0.47 mm.

Conclusions

3D imaging of the facial recess and round window can be used to identify the facial recess before surgery. This may help to avoid injury to the chorda tympani nerve during posterior tympanotomy, and make it easier to insert the electrode array during CI by creating a large enough posterior tympanotomy to avoid injury to the facial nerve, which can cause immediate or delayed facial palsy.     

正常中耳64排螺旋CT仿真内窥镜和听骨链三维重建

目的:探讨64排螺旋CT仿真内窥镜(CTVE)和听骨链表面遮盖法(SSD)成像对正常中耳结构的显示情况及其技术方法。方法:无临床症状、临床检查未见异常、CT显示正常者35耳,行中耳CTVE及听骨链SSD成像,重建图与正常图谱、二维CT图对照。结果:CTVE100%(35/35)清晰显示大部分听骨链的结构及鼓室各壁结构;CTVE对镫骨前后脚的显示率分别为68.6%(24/35)和74.3%(26/35),CTVE尤其清晰显示后鼓室重要结构;听骨链SSD成像100%(35/35)清晰显示听小骨各结构,尤其是完全显示了镫骨前后脚及脚板。结论:64排螺旋CT的CTVE及听骨链SSD成像,能够建立正常中耳立体解剖结构模式,立体、清晰地显示正常中耳腔内部及各壁重要的解剖结构,为临床对中耳三维结构的观察提供更直接的影像学资料,该技术方法简单、快速,值得推广。     

A computerized tomography study of the morphological interrelationship between the temporal bones and the craniofacial complex

The hypothesis that the temporal bones are at the center of the dynamics of the craniofacial complex, directly influencing facial morphology, has been put forward long ago. This study examines the role of the spatial positioning of temporal bones (frontal and sagittal inclination) in terms of influencing overall facial morphology. Several 3D linear, angular and orthogonal measurements obtained through computerized analysis of virtual models of 163 modern human skulls reconstructed from cone-beam computed tomography images were analyzed and correlated. Additionally, the sample was divided into two subgroups based on the median value of temporal bone sagittal inclination [anterior rotation group (n = 82); posterior rotation group (n = 81)], and differences between groups evaluated. Correlation coefficients showed that sagittal inclination of the temporal bone was significantly (P < 0.01) related to midline flexion, transversal width and anterior-posterior length of the basicranium, to the anterior-posterior positioning of the mandible and maxilla, and posterior midfacial height. Frontal inclination of the temporal bone was significantly related (P < 0.01) to basicranium anterior-posterior and transversal dimensions, and to posterior midfacial height. In comparison with the posterior rotation group, the anterior rotation group presented a less flexed and anterior-posteriorly longer cranial base, a narrower skull, porion and the articular eminence located more superiorly and posteriorly, a shorter posterior midfacial height, the palatal plane rotated clockwise, a more retrognathic maxilla and mandible, and the upper posterior occlusal plane more inclined and posteriorly located. The results suggest that differences in craniofacial morphology are highly integrated with differences in the positional relationship of the temporal bones. The sagittal inclination of the temporal bone seems to have a greater impact on the 3D morphology of the craniofacial complex than frontal inclination.     

Anatomical education and surgical simulation based on the Chinese Visible Human: a three-dimensional virtual model of the larynx region

Anatomical knowledge of the larynx region is critical for understanding laryngeal disease and performing required interventions. Virtual reality is a useful method for surgical education and simulation. Here, we assembled segmented cross-section slices of the larynx region from the Chinese Visible Human dataset. The laryngeal structures were precisely segmented manually as 2D images, then reconstructed and displayed as 3D images in the virtual reality Dextrobeam system. Using visualization and interaction with the virtual reality modeling language model, a digital laryngeal anatomy instruction was constructed using HTML and JavaScript languages. The volume larynx models can thus display an arbitrary section of the model and provide a virtual dissection function. This networked teaching system of the digital laryngeal anatomy can be read remotely, displayed locally, and manipulated interactively.     

Visualization of the temporal bone of the Chinese Visible Human

Temporal bone anatomy is very difficult to understand. After dataset acquisition of the first Chinese Visible Human, we processed the two-dimensional images to build a digitized visible model of the temporal bone and explore the role of virtual endoscopy in the inner ear. On a SGI workstation three-dimensional computer reconstructions of the ear were generated from the Chinese visible human dataset, viewing the middle and inner ear imitating the traditional otoscopy. The three-dimensional data of the temporal bone were then converted to STL format, and the temporal bone replica were fabricated with rapid prototyping by laminated object manufacturing. The virtual model of the ear was successfully completed, and the virtual endoscopy improved three-dimensional visualization of the middle and inner ear. Physical replica of the temporal bone were built with paper; the accuracy was ±0.2 mm. The reconstructed model and the replica of the temporal bone can be used to make preoperative plans in the complicated otoneurosurgical operations, allowing various surgical exercises to be carried out on the three-dimensional stereophysical model. The virtual endoscopy stands as a promising new visualization technique for elucidation of the middle and inner ear and reveals a tremendous potential in both clinical and educational settings, providing morphological data for the image diagnosis and otoneurosurgery.This research was supported by the National Science Fund of China (NSFC) No. 39925022, No. 30720698