虚拟现实技术在微创化乙状窦前入路显露颈静脉结节的解剖研究中的应用

目的 在虚拟现实系统中探讨合理缩小乙状窦前入路显露颈静脉结节的手术路径操作范围。方法 采集15例成人尸头标本CT和MRI影像数据构建岩骨和后颅窝的虚拟现实解剖模型。在颅盖中选取乳突尖部为乙状窦前入路的开颅标志点,在颅底中选择颈静脉结节前缘为目标显露区的标志点,以开颅和显露标志点连线为轴线作出直径为2 cm的圆柱状模拟乙状窦前入路手术路径,再缩小圆柱直径至1 cm进行微创化设计;观察和测量微创化前后手术路径中解剖结构显露情况,采用配对t检验进行比较分析。结果 微创化前路径中包含乙状窦前缘、颈静脉球下端、颈内静脉和岩下窦,经过舌咽神经、迷走神经、副神经和舌下神经,包含部分颈内动脉的体积为(41.57±2.38) mm³和小脑前下动脉的体积为(60.64±2.13) mm³。微创化后手术路径经过部分颈静脉球、颈内静脉和岩下窦,经过副神经。微创化后手术路径体积以及路径中所包含骨性结构、颅神经、静脉结构体积分别为(2 168.00±12.90)mm³、(26.43±1.71)mm³和(780.32±18.74)mm³,均小于微创化前的(7 083.40±156.24)mm³、(130.24±1.88)mm³和(2 411.00±162.86)mm³,差异均有统计学意义(t=114.349、217.286、54.402, P值均＜0.01)。结论 模拟手术路径中,操作方向和范围确定,可实现量化比较。乙状窦前入路显露颈静脉结节的微创化手术路径有助于减少术中对骨性结构的磨除和神经血管的损伤。

Anatomic research of minimally invasive surgical route for presigmoidal approach exposing jugular tubercle by virtual reality skill

Objective To discuss how to scale down the range of surgical route for the presigmoidal approach exposing jugular tubercle based on virtual reality image model. Methods CT and MRI images of fifteen adult cadaver heads were used to establish virtual reality anatomic model of petrous bone and posterior cranial fossa. The mastoidal tip was selected as landmark point of craniotomy through presigmoidal approaches. The anterior edge of jugular tubercle was selected as exposure landmark points on the skull base. The lines between craniotomy and exposure landmark points were used as axis to outline cylinders with diameter of 2 cm simulating surgical routes of and presigmoidal approach. Minimally invasive design was made by reducing the diameter of cylinder to 1 cm. Anatomic exposure before and after minimally invasive design were observed and measured. Statistical comparison was launched by paired t test. Results Surgical route before minimally invasive design passed through the anterior edge of sigmoid sinus, the bottom of jugular bulb, internal jugular vein and inferior petrosal sinus. The route also passed through glossopharyngeal nerve, vagus nerve, accessory nerve and hypoglossal never, and then, involved partial internal carotid artery (41.57±2.38) mm³] and anterior inferior cerebellar artery (60.64±2.13) mm³]. The surgical route following minimally invasive design passed through partial jugular bulb, internal jugular vein, inferior petrosal sinus and accessory nerve. The volumes of surgical route before minimally invasive design, osseous structures, cranial nerve and vein involved (2 168.00±12.90)mm³ vs (7 083.40±156.24)mm³,(26.43±1.71)mm³ vs (130.24±1.88)mm³, (780.32±18.74)mm³ vs (2 411.00±162.86)mm³] were less than those of surgical route following minimally invasive design with statistical significance (t=114.349, 217.286, 54.402, all P values＜0.01). Conclusions Simulative surgical route can determine operative direction and range. Compared with route before minimally invasive design, minimally invasive route of presigmoidal approach exposing jugular tubercle can reduce intraoperative bone drilling and injure of neurovascular structures.