CT仿真内镜显示鞍底神经血管及其解剖标志的临床意义

目的探讨CT仿真内镜(CT virtual endoscopy,CTVE)显示鞍底深部血管神经及其表面解剖标志在经蝶手术中的应用价值。方法 128例垂体瘤经蝶手术中,利用Navigator Guide软件对术前垂体CT检查数据进行蝶窦CTVE重建,了解CTVE对鞍底血管、神经及其解剖标志的显示情况。结果 CTVE能以三维图像的形式显示颈内动脉隆起、视神经管隆起、视神经管-颈内动脉隐窝,三者的显示率分别为:43.4%(111例)、37.5%(96例)、57.0%(146例)。通过传输函数设计技术(transfer functions),CTVE能透视显示出增强的颈内动脉100%(256例),可观察到有43.8%(112例)中隔附着于颈内动脉的浅面。通过动态调高观察阈值,CTVE能显示视神经管99.6%(255例),可观察到约17.3%(44例)中隔附着于视神经管表面。结论在经蝶手术中,术前CTVE能以三维图像的形式显示鞍底深部血管、神经及其解剖标志;术中能指导对上述鞍底血管、神经的辨认及鞍底骨窗形成。

Preoperative CTVE images of sphenoidal neurovascular structures and the applications for transsphenoidal pituitary surgery

Objective　To investigate the CTVE images of sphenoidal neurovascular structures and their anatomic landmarks, and evaluate their applications for transsphenoidal pituitary surgery.　Methods　For 128 cases underwent transsphenoidal pituitary surgeries, CTVE images of sphenoid sinus were reconstructed from the presurgical CT datas by Navigator Guide software, and then the images of underlying neurovascular structures and their superficial landmarks were investigated.  Results  CTVE could display the three-dimensional neurovascular landmarks of sphenoid sinus. The display rates of carotid prominence, optic prominence and opticocarotid recess were 43.4％（111 cases）, 37.5％（96 cases）and 57.0％（146 cases）respectively. CTVE could depict carotid arteries underlying the sellae by Transfer Functions completely, and optic canals by increasing the threshold about 99.6% (255 cases), furthermore, 43.8％(112 cases) of carotid arteries and 17.3％(44 cases) of optic canals attached superficially on the sphenoid septation could be observed by CTVE.  Conclusions    CTVE can depict the neurovascular features underlying the sellae and their superficial landmarks under a three-dimensional mode, which is a valuable tool for depicting the sellar neurovascular landmarks preoperatively and locating the adjacent structures during transsphenoidal pituitary surgery.