虚拟现实术前计划在特发性面肌痉挛微血管减压术中的应用

目的评价虚拟现实术前计划用于特发性面肌痉挛导微血管减压术的效果。方法收集33例做虚拟现实术前计划（计划组）和27例未做虚拟现实术前计划（对照组）的特发性面肌痉挛患者的病例资料进行回顾性分析。计划组患者分别行脑血管CT和头颅MRI检查,影像数据输入Vitrea虚拟现实系统进行三维重建,模拟枕下乙状窦后入路显露面听神经复合体,判断责任血管和面神经的空间关系,在术前计划基础上进行面神经微血管减压术。比较2组手术疗效和并发症发生率。结果2组患者责任血管均为小脑前下动脉,虚拟现实术前计划中面神经与责任血管空间关系清晰显示,责任血管判定结果与术中观察结果一致。计划组和对照组Cohen分级0级比例差异有统计学意义[100．0％（33例）比85．2％（23例）]（P=0．036）,手术疗效总体良好率差异无统计学意义[100．0％（33例）比85．2％（23例）]（P=0．450）。并发症总体发生率差异无统计学意义[0．0％比11．1％（3例）]（P=0．085）。结论虚拟现实术前计划有助于清晰直观地显示面神经与责任血管的空间关系,可提高手术疗效和安全性。

Preoperative plan of microvascular decompression for hemifacial spasm utilizing virtual reality technique

Objective To evaluate curative effect of microvascular decompression for hemifacial spasm under the direction of virtual reality preoperative plans to observe the relation between responding vessel and facialacoustic nerve complex. Methods CT angiography and head MRI scans were performed in 33 cases suffering hemifacial spasm. Image data was putted into Vitrea virtual reality system to reconstruct and simulate exposure of facial-acoustic nerve complex through suboccipito-retrosigmoidal approach. Spatial relationship between responding vessel and facial nerve was identified to direct microvascular decompression. Patients without preoperative plans were enrolled as control group. Results Visualization effects of spatial relation between facial nerve and responding vessels were good. Anterior inferior cerebellar artery was identified as a responding vessel for all cases in two groups. Cohen grade zero in two groups were different with statistical significance [ 100.0% （33 cases）vs 85.2% （23 cases） ] （ P = 0. 036 ）. Statistical significance was not shown regarding incidence of complication [ 0 vs 11.1% （ 3 cases） ] （ P = 0.085 ）. Conclusion Virtual reality preoperative plan is helpful for displaying spatial relation between facial nerve and responding vessel clearly and objectively, which ensures safe and effective results.