CT三维重建和导航下内镜视神经管减压的解剖学研究

目的 为CT三维重建和导航下内镜视神经管减压手术提供解剖学依据.方法 实验研究.对8例(16侧)成人湿性尸头视神经管及其重要毗邻结构进行解剖和测量,比较分析内镜下CT三维重建和导航定位的视神经管结构与实体解剖下视神经管结构的差异.采用配对t检验.结果 内镜下视神经管隆起、颈内动脉隆起和视神经-颈内动脉隐窝出现率分别为62.5％、75％和75％,与实体解剖结果完全吻合.内镜下视神经管眶口内壁中点到鼻小柱基底前缘的距离为(71.19±4.00)mm、视神经管颅口内壁中点到鼻小柱基底前缘的距离为(79.69±3.65)mm、视神经管内侧壁长度为(10.00±1.71)mm、视神经管眶口直径为(4.46±0.56)mm、视神经管颅口直径为(4.71±0.42)mm,与实体解剖测量结果比较差异无统计学意义.结论 CT三维重建和导航技术可以准确定位视神经管,为安全有效的内镜视神经管减压手术提供保障.

The use of a CT-based navigation system for the endoscopic anatomy of the optic canal

Objective To recognize the endoscopic anatomy of the optic canal using a computer-assisted navigation system based on three-dimensional computed tomography (CT).Methods This was an experimental study.Eight adult damp cadaveric heads were studied bilaterally (n=16).We approached each optic canal through each nostril assisted by the CT-based navigation system to measure the optic canal and its related structures and compare it to the gross anatomy.Results In endoscopic anatomy,the distinguishing ratios for optic protuberance (OP),carotid protuberance (CP),and opticocarotid recess (OCR) were 62.5％,75％,and 75％,which were consistent with the gross anatomy.In the endoscopic anatomy,the distances from the midpoint of the medial wall of the optic canal orbital aperture and cranial aperture to the anterior nasal spine were 71.19±4.00 mm and 79.69±3.65 mm,respectively.The mean length of the medial wall of the optic canal was 10.00±1.71 mm.The mean diameters of the optic canal orbital aperture and cranial aperture were 4.46±0.56 mm and 4.71±0.42 mm,respectively.There was no statistically significant difference between CT endoscopic anatomy and gross anatomy (P＞0.05).Conclusion The computer-assisted navigation system based on the three-dimensional CT can map the optic canal accurately.With the help of the CT-based navigation system,a surgeon can perform the operation safely and effectively.