3D-CT颅骨重建技术在枕下乙状窦后入路开颅术中的应用

目的探讨3D-CT颅骨重建在枕下乙状窦后开颅术中的指导作用。方法回顾性分析2014年12月至2017年3月枕下乙状窦后入路手术治疗的40例桥小脑角区病变的临床资料,其中左侧开颅22例,右侧18例。术前应用3D-CT颅骨重建技术重建颅后窝骨质,明确横窦、乙状窦静脉窦沟及星点、顶乳缝前角、枕乳缝、二腹肌沟,在颅骨内表面借横窦乙状窦沟交界处设置"关键孔",颅骨外表面测量"关键孔"与顶乳缝前角、星点及二腹肌沟距离及角度。根据术前规划进行开颅。结果术中无静脉窦破裂出血,无明显骨质缺损,开颅快捷。"关键孔"能清晰暴露横窦乙状窦交界处有34例,未能清晰暴露6例。左侧星点与"关键孔"中心距离为6.7~20.6 mm,平均(14.0±3.6)mm;右侧6.9~19.4 mm,平均(13.9±3.7)mm。星点与"关键孔"中心连线及星点与二腹肌沟连线组成的角度左侧(4~45)°,平均(25±12)°;右侧(4~49)°,平均(24±13)°。结论应用3D-CT颅骨重建技术协助枕下乙状窦后入路开颅,操作简单快捷,骨瓣缺损少,有利于静脉窦保护。

Application of three-dimensional CT cranial bones reconstruction technique to surgery through suboccipital retrosigmoid approach

Objective To investigate the role of three-dimensional CT (3D-CT) cranial bones reconstruction technique in the surgery through suboccipital retrosigmoid approach. Methods The clinical data of 40 patients with cerebellopontine angle lesions treated by surgery through suboccipital retrosigmoid approach from December, 2014 to March, 2017 were analyzed retrospectively. The lesions were in the left sides of the brains in 22 patients and in the right sides in 18. The cranial bones and cranial fossa were preoperatively reconstructed by 3D-CT reconstruction technique in all the patients. The transverse sinus, sigmoid sinus sulcus, asterion, anterior horn of parietomastoid sutures, occipitomastoid suture and digastric groove were ascertained on 3D model of head. The 'key hole' on the inner surface of the skull was designed under the help of transverse sinus and sigmoid sinus junction. The angle and distance between the 'key hole' and anterior horn of parietomastoid sutures, or asterion, or digastric groove on the external surface of the skull were measured. Craniotomy was performed according to the preoperative plan. Results There were no intraoperative venous sinus rupture and obvious bone defect. The craniotomy was quick. The 'key hole' was clearly exposed at the junction of transverse sinus and sigmoid sinus in 34 patients and not in 6 patients. The distance between the center of the 'key hole' and left asterion ranged from 6.7 to 20.6 mm [mean, (14± 3.6) mm] and the distance between the centre of the 'key hole' and the right asterion ranged from 6.9 to 19.4mm [mean, (13.9±3.7) mm]. The left and right angles between the line connecting the asterion and the centre of the 'key hole' and line connecting the asterion and digastric groove ranged from 4° to 45° (mean 25° ± 12° ) and from 4° to 49° (mean, 24° ± 13° ) respectively. Conclusions The 3D-CT cranial bone reconstruction technique is easy and can be used in the patients with intracranial lesions undergoing surgery through suboccipital retrosigmoid approach, in whom less defect of bone flap and good protection of venous sinus can be realized by 3D-CT cranial bone reconstruction technique.