经鼻入路处理斜坡病变的虚拟影像解剖研究

目的 在虚拟现实(VR)环境下观察经鼻入路虚拟解剖,并建立斜坡区虚拟解剖模型,探讨该方法的临床应用价值.方法 选择20例无鞍区及斜坡区病变者,其中男11例,女9例,年龄25 ～ 70(43.0±0.3)岁,行16排螺旋CT头部薄层扫描血管造影及MRI薄层扫描检查,数据导入Dextroscope图像工作站,进行斜坡区三维重建及经鼻人路虚拟解剖观察.结果 20例均成功实现了斜坡区相关结构的虚拟重建,并进行了相关解剖数据的测量.同时应用VR系统模拟经鼻人路,明确经鼻人路斜坡骨质磨除界限,斜坡骨质开窗侧方的扩展受到斜坡旁颈内动脉的限制,上方受到鞍底的限制,下方受到上颌骨及硬腭的限制而无法完全显露下斜坡.结论 VR技术可精确重建斜坡区解剖模型,并可模拟手术入路,为经鼻人路处理斜坡病变提供影像解剖学依据.

Virtual imaging anatomy of transnasal approach to the clivus

Objective To observe the virtual anatomy via transnasal approach in a virtual-reality (VR) environment, and to establish a virtual anatomical model of clival region and explore the application value of the virtual-reality technology. Methods Twenty patients(males 11,females 9,aged from 25 to 70 years old with a mean of 43±0.3 years) with no pathological changes in the sellar area and clivus underwent CT angiography with Discovery Ultra 16 and 3.0T MRI thin-slice scan.The data were collected and inputted into the Dextroscope in the DICOM format.Virtual observation of anatomy via transnasal approach and three-dimensional reconstruction of clivus were carried out in the VR environment. Results Virtual reconstruction and measurements of clivus were successfully performed in the 20 patients.The simulation of transnasal approach was also carried out in the VR environment.The lateral side of clival bone removal through transnasal approach was limited by internal carotid artery,the superior limit was sellar floor and the lower clivus could not be revealed completely because of the restriction of the maxilla and hard palate.Conclusions Virtual reconstruction of the clivus and simulation of transnasal approach can be performed exactly by VR technology,which provides imaginal and anatomical basis in dealing with clivus lesions via transnasal approach.