CAJ | 학술논문

目的：探讨三叉神经节经皮射频热凝术（ PRT）进针安全深度，为颅内进针避免损伤血管神经提供解剖学依据。方法：选择21例成人颅底解剖标本，用游标卡尺从颅内测量卵圆孔内侧缘中点至破裂孔外侧缘中点的距离（ A）和卵圆孔内侧缘中点至三叉神经压迹上缘最高点的距离（ B）；同时从颅外同一方向测量卵圆孔内侧缘至破裂孔外侧缘的距离（C）和破裂孔外侧壁垂直深度（D）；用螺旋CT扫描颅底，测量颅底水平位颅中窝最大密度投影（ MIP）图像上同一方向卵圆孔内侧缘至破裂孔外侧缘的距离（ E）。然后对距离C和安全距离及距离E进行统计分析，确定距离E是否可以作为指导不同患者进行PRT治疗时个体化的颅内安全进针深度。结果：①颅内卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（1．19±0．15）cm，左侧（1．20±0．14）cm；②颅内卵圆孔内侧缘中点至三叉神经压迹顶点的距离为右侧（1．51±0．17）cm，左侧（1．49±0．16）cm；③颅外卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（0．92±0．09cm），左侧（0．92±0．10）cm；④破裂孔外侧壁中点垂直深度为右侧（0．55±0．07） cm，左侧（0．55±0．07）cm；⑤中颅底水平位螺旋CT最大密度投影（MIP）图像上同一方向卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（1．00±0．17） cm，左侧（1．00±0．17） cm，与距离C差异无统计学意义（ P＞0．05）。结论：三叉神经节PRT治疗时颅内进针深度不应超过1．00 cm，临床上可用中颅底水平位螺旋CT最大密度投影（ MIP）技术显示与相同方向卵圆孔内侧缘中点至破裂孔外侧缘中点的距离的一致性，来指导不同患者进行PRT治疗时个体化的颅内安全进针深度。
목적：탐토삼차신경절경피사빈열응술（ PRT）진침안전심도，위로내진침피면손상혈관신경제공해부학의거。방법：선택21례성인로저해부표본，용유표잡척종로내측량란원공내측연중점지파렬공외측연중점적거리（ A）화란원공내측연중점지삼차신경압적상연최고점적거리（ B）；동시종로외동일방향측량란원공내측연지파렬공외측연적거리（C）화파렬공외측벽수직심도（D）；용라선CT소묘로저，측량로저수평위로중와최대밀도투영（ MIP）도상상동일방향란원공내측연지파렬공외측연적거리（ E）。연후대거리C화안전거리급거리E진행통계분석，학정거리E시부가이작위지도불동환자진행PRT치료시개체화적로내안전진침심도。결과：①로내란원공내측연중점지파렬공외측연중점적거리위우측（1．19±0．15）cm，좌측（1．20±0．14）cm；②로내란원공내측연중점지삼차신경압적정점적거리위우측（1．51±0．17）cm，좌측（1．49±0．16）cm；③로외란원공내측연중점지파렬공외측연중점적거리위우측（0．92±0．09cm），좌측（0．92±0．10）cm；④파렬공외측벽중점수직심도위우측（0．55±0．07） cm，좌측（0．55±0．07）cm；⑤중로저수평위라선CT최대밀도투영（MIP）도상상동일방향란원공내측연중점지파렬공외측연중점적거리위우측（1．00±0．17） cm，좌측（1．00±0．17） cm，여거리C차이무통계학의의（ P＞0．05）。결론：삼차신경절PRT치료시로내진침심도불응초과1．00 cm，림상상가용중로저수평위라선CT최대밀도투영（ MIP）기술현시여상동방향란원공내측연중점지파렬공외측연중점적거리적일치성，래지도불동환자진행PRT치료시개체화적로내안전진침심도。
Objective:To explore puncture depth in percutaneous radio -frequency thermocogulation of tri-geminal ganglion and provide anatomic basis to avoid intracranial puncture lesion of vessels and nerves .Methods:21 cranial base specimens of the adult were selected .The distance between the midpoint of the medial border of the fora-men ovale and the midpoint of the lateral border of the foramen lacerum was measured by vernier caliper ( A) and the distance between the midpoint of the medial border of the foramen ovale and the highest point of the superior margin of the trigeminal impression ( B) on the internal surface of the cranial base specimens;At the same time ,the distance between the medial border of the foramen ovale and the lateral border of the foramen lacerum at the same direction on the external surface of the cranial base specimens was measured (C) and the vertical diatance of the lateral wall of the foramen lacerum(D) scan horizontally the cranial base with spiral CT , then measure the distance between the medial border of the foramen ovale and the lateral border of the foramen lacerum at same direction on the maximum intensity projection(MIP) images(E) the distance C and the safe distance and the distance E was analyzed to deter-mine whether the distance E can be used to indicate the individual and safe needle depth into the skull at different pa -tients who were treated by PRT .Results:The distance between the midpoint of the medial border of the foramen ovale and the midpoint of the lateral border of the foramen lacerum on the internal surface of the cranial base specimens was 1.19 ±0.15cm(right) and 1.20 ±0.14cm(left);②The distance between the midpoint of the medial border of the foramen ovale and the vertex of the trigeminal impression on the internal surface of the cranial base specimens was 1. 51 ±0.17cm(right) and 1.49 ±0.16cm(left);③The distance between the midpoint of the medial border of the fora-men ovale and the midpoint of the lateral border of the foramen lacerum on the external surface of the cranial base specimens was 0.92 ±0.09cm(right) and 0.92 ±0.10cm(left);④The vertical distance of the lateral wall of the fo-ramen lacerum was 0.55 ±0.07cm(right) and 0.55 ±0.07cm(left); ⑤The distance between the midpoint of the medial border of the foramen ovale and the midpoint of the lateral border of the foramen lacerum at same direction on the maximum intensity projection(MIP) imaging was 1.00 ±0.17cm(right) and 1.00 ±0.17cm(left),there was no statistical significance between the distance C and the distance E .Conclusions:The intractanial needle depth should be shorter than 1.00cm.In clinic we can display the accordance to the distance between the medial border of the fora -men ovale and the lateral border of the foramen lacerum at the same direction on the maximum intensity projection ( MIP) imaging by scanning the cranial base horizontally with spiral CT , then use it to indicate the individual safe needle depth into the skull at different patients treated by PRT .