颞叶基底桥静脉解剖的三维虚拟现实技术研究及临床应用

目的　评估三维虚拟现实技术显示颞叶基底桥静脉与实际解剖的差异及其在横跨颅中、后窝肿瘤手术中的应用。 方法　20具尸头标本和25例颅中、后窝肿瘤患者分别分成实际解剖组和虚拟解剖组。虚拟解剖组头颅MRA、CTA等在工作站融合后，虚拟环境下解剖颞叶基底桥静脉，而实际解剖组在显微镜下解剖，比较两组静脉数目、形态和Labbé静脉类型。 结果 颞叶基底桥静脉有4型。实际解剖组：静脉湖型17.5%，烛台型40%，单根型20%，多根型22.5%；虚拟解剖组：静脉湖型16%，烛台型42%，单根型18%，多根型24%。实际解剖组静脉属支213根，87汇入点；而虚拟解剖组分别为167属支，81汇入点。颞叶基底桥静脉汇入点分布：实际解剖组横窦区域52.87%，小脑幕区域24.13%，岩上窦区域23.0%；虚拟解剖组横窦区域54.35%，小脑幕区域23.91%，岩上窦区域23.10%。 结论 虚拟现实技术可以精确显示颞叶基底桥静脉的解剖特点，为颅中、后窝骑跨肿瘤手术入路选择提供合理依据。

Researches on anatomical features of temporal bridging veins with three dimensional virtual reality technique and its clinical applications

Objective　To evaluate the application of virtual reality technology in neurosurgical anatomy we compared the virtual three-dimensional (3D) microanatomy of the temporal bridging veins as part of the resection of tumors across the petrosal crest in 25 patients against the actual microanatomy of the temporal bridging veins on 20 cadaveric head sets.　Methods　The experiment was carried out using two groups of data: a virtual group (VR Group) made up by 25 clinical cases and a physical body group (PB Group) made up by 20 cadaveric head sets. In the physical body group, the temporal bridging veins on the cadaveric heads were examined under the microscope for number of their tributaries and measurement of the distance between emptying point on sinus of Labbé vein and sigmoid transverse sinus. In the virtual group, the dissection of the temporal bridging veins was simulated on Dextroscope. We compared the anatomical features of temporal bridging veins in two groups. Virtual reality technology was used in the planning of 25 cases for which the anatomy of temporal bridging veins was studied carefully by the neurosurgical team.　Results　Four basic configurations of veins were found: venous lakes running in the tentorium before emptying into the sinuses, accounting for 17.5%; candelabra of veins uniting to form one large drainage, accounting for 40%; single independent draining veins, accounting for 20% and multiple independent draining veins , accounting for 22.5% in physical body group. venous lake, accounting for 16%, candelabra of veins uniting to form one large drainage, accounting for 42%; single independent draining veins, accounting for 18% and multiple independent draining veins, accounting for 24% in virtual group. 213 tributaries and 87 terminations of temporal bridging veins were found in cadaveric heads, whereas 167 tributaries and 81 terminations of temporal bridging veins were found in the virtual group. The distributions of anatomical terminations of temporal bridging veins were divided into three groups: transverse area 52.87%, tentorium area 24.13% and petrosal area 23.0% in physical body group, whereas 54.35%,23.91% and 21.74% in virtual group, respectively. The proportion of fore-placed type veins of Labbé is 7.69% in physical body group and 8.33% in virtual group (P >0.05). The anatomical features of Labbé veins found during the operation of the 25 patients with tumors extended from middle fossa to posterior fossa and were consistent with what was seen in presurgical planning.　Conclusions　Virtual reality technology can accurately simulate the anatomical feature of the temporal bridging veins which facilitates the planning of individual operations in neurosurgery.