枕下乙状窦后入路显露颈静脉孔区微创策略的虚拟现实研究

目的 在构建虚拟现实解剖模型基础上探讨枕下乙状窦后入路微创显露颈静脉孔区的显微解剖特征.方法 5例尸体头颅行CT和MRI扫描,影像数据输入虚拟现实系统构建面听神经复合体三维解剖模型,在颅盖和颅底中选择骨性标志点设计枕下乙状窦后入路路径,观察和测量路径微创化前后对颈静脉孔区的显露情况,并进行比较分析.结果 模拟枕下乙状窦后入路显露颈静脉孔区的路径均由横窦下方穿过,路径中清晰显示所包含的神经、血管等解剖结构的空间层叠顺序,均不包含椎动脉和小脑后下动脉.微创化后手术路径不包含面听神经复合体和小脑前下动脉.通过测量和比较分析,手术路径体积和路径中小脑半球体积：微创化后较微创化前明显减小,差异均有统计学意义（t分别为36.331,16.775;P＜0.01）;路径中显露后组颅神经的体积：微创化前后差异无统计学意义（t=0.021,P=0.984）.结论 枕下乙状窦后入路微创化手术路径有助于在颈静脉孔区的解剖显露中减少对重要神经血管结构的损伤.

Research of minimally invasive design for suboccipito-retrosigmoidal approach to expose jugular foramen region by virtual reality skill

Objective To discuss microanatomy features of jugular foramen region in suboccipito retrosigmoidal minimally invasive approach based on virtual reality image model. Methods CT and MRI scans were performed to five adult cadaver heads, and then, image data was inputted into Vitrea virtual reality system to establish three dimensional anatomy model of jugular foramen region. Suboc cipito retrosigmoidal approach was simulated by selecting osseous landmark points on the calvarias and skull base. Anatomic exposures in surgical trajectory were observed and measured following minimally invasive design. Statistical comparison was launched by paired test. Results Routes simulating suboe cipito retrosigmoidal approach for exposure of jugular foramen region passed under the inferior edge of transverse sinus. Special sequence of nerves and vessels in the route was displayed clearly. Vertebral ar tery and posterior inferior cerebellar artery did not show in route. Facialacoustic nerve complex and an terior inferior cerebellar artery did not show in minimally invasive route. Measure and comparative analy sis showed that volumes of route and cerebellar involved before minimally invasive design were more than that after minimally invasive design with statistically significant difference. Comparison did not show sig nificant differences for the volumes of lower cranial nerves between routes before and after minimally in vasive design. Conclusions Minimally invasive route of suboccipito retrosigmoidal approach is helpful to reduce surgical injure of vital nerves and vessels in anatomic exposure for jugular foramen region.