颅眶手术入路双容积融合影像的临床应用解剖学研究

目的 探讨双容积融合影像解剖学对颅眶手术的临床应用价值。方法 收集100例DSA检查无异常发现的病人，利用其三维脑血管成像及三维颅骨成像数据，在Siemens双C臂机Syngo后处理工作站，进行三维数据融合，获得3D-DSA/3D-CT的融合影像，选择颅眶区手术入路的步骤，对血管影像与颅骨相关及毗邻关系进行观察并测量与手术入路相关的数据，在三维静态（冠状位、矢状位、轴位及与手术相关的角度）与连续动态融合影像模拟手术入路步骤进行操作。结果 观察发现多数眼动脉起始部位于颈内动脉床突段内侧，沿视神经管外下方走行。颅骨左右径平均（143.89±5.78）mm，颅骨前后径平均（173.14±5.68）mm，双侧眼动脉起始处至视神经管上壁距离平均（7.32±2.42）mm，视神经孔到眶上裂距离平均（2.42±0.69）mm。在三维融合影像中发现2例眼动脉未经视神经管入眶的变异。结论 颅眶手术入路双容积融合影像，与单一影像相比，可显示手术入路的相互比邻解剖关系，对手术有更精准的参考价值。应用手术对象的融合影像显示手术入路，可达到标准化、个体化，对手术参考价值更大，更符合手术真实情况。

Clinical anatomic study of double volume fusion imaging and its value in craniotomy via cranio-orbital approach

Objective To explore the clinical application value of double volume fusion imaging in craniotomy via cranio-orbital approach. Methods The imaging data were colledcted from 100 patients with no abnormal findings in DSA examination. The data of 3D cerebrovascular imaging and 3D skull imaging were used to obtain 3D-DSA/3D-CT fusion image at the Siemens dual-C-arm Syngo post-processing workstation. The mimic surgery via cranio-orbital approach was performed to observe the correlation and adjacent relationship between the vascular image and the skull and to measure the data related to the surgical approach in the three-dimensional static (coronal, sagittal, axial and surgically related angle) with continuous dynamic fusion images. Results It was observed that the start of most ophthalmic arteries was located inside the bed segment of the internal carotid artery and traveled along the outer and lower sides of the optic canal. The average diameter of the skulls from left to right was (143.89±5.78) mm, and the average diameter of the skulls from anterior to posterior was (173.14±5.68) mm. The average distance from the start of the bilateral ophthalmic artery to the upper wall of the optic canal was (7.32±2.42) mm. The average distance from optic foramen to supraorbital fissure was (2.42±0.69) mm. Two variations of the ophthalmic artery into the orbit without optic canal were found in three-dimensional fusion images. Conclusions Compared with the single image, the double-volume fusion image of the surgery via cranio-orbital approach can show the adjacent anatomic relationship of the surgical approach, which has more accurate reference value for surgery. During the operation, the fusion image of the surgical object using to show that the surgical approach is standardized and individualized.