CAJ | 학술논문

目的比较三维虚拟现实技术显示在颞底经天幕入路中颞底桥静脉与实际手术中颞底桥静脉差异,探讨其在横跨中后颅凹肿瘤手术中的应用价值.方法实验分为虚拟组和手术组,其中虚拟组中25例中后颅凹肿瘤患者,手术前进行头颅磁共振(MR)和CT血管造影(CTA)扫描,然后数据导入Dextroscope工作站,对于不同来源数据融合在虚拟环境下解剖颞底桥静脉,记录颞底桥静脉数目、形态和labbé静脉类型,25例患者中23例采用颞底经天幕入路,术中对颞底静脉和汇入点进行观察和记录,最后再与手术中所见进行比较.结果虚拟组中颞底桥静脉呈4种解剖形态:静脉湖型16％(8侧半球),烛台型42％(21侧半球),单根型18％(9侧半球),多根型24％(12侧半球)；手术组分别为43.47％(10)、43.47％(10)、17.39％(4)、26.08％ (6).颞底桥静脉汇入点分布:虚拟组横窦区域54.35％,天幕区域23.91％,岩上窦区域23.10％；手术组分别为53.33％(24)、26.67％(12)、20.00％ (9).虚拟组Labbé静脉汇入点到静脉窦角距离为(20.12±2.51) mm,前置性Labbé静脉8.33％；手术组分别为(24.12±3.68) mm、0.25例患者中有23例使用颞底经天幕入路,术中所见桥静脉与虚拟研究中吻合.结论虚拟现实技术可以精确显示颞底桥静脉的解剖特点,为中后颅凹骑跨肿瘤手术入路选择提供合理依据.
목적 비교삼유허의현실기술현시재섭저경천막입로중섭저교정맥여실제수술중섭저교정맥차이,탐토기재횡과중후로요종류수술중적응용개치.방법 실험분위허의조화수술조,기중허의조중25례중후로요종류환자,수술전진행두로자공진(MR)화CT혈관조영(CTA)소묘,연후수거도입Dextroscope공작참,대우불동래원수거융합재허의배경하해부섭저교정맥,기록섭저교정맥수목、형태화labbé정맥류형,25례환자중23례채용섭저경천막입로,술중대섭저정맥화회입점진행관찰화기록,최후재여수술중소견진행비교.결과 허의조중섭저교정맥정4충해부형태:정맥호형16％(8측반구),충태형42％(21측반구),단근형18％(9측반구),다근형24％(12측반구)；수술조분별위43.47％(10)、43.47％(10)、17.39％(4)、26.08％ (6).섭저교정맥회입점분포:허의조횡두구역54.35％,천막구역23.91％,암상두구역23.10％；수술조분별위53.33％(24)、26.67％(12)、20.00％ (9).허의조Labbé정맥회입점도정맥두각거리위(20.12±2.51) mm,전치성Labbé정맥8.33％；수술조분별위(24.12±3.68) mm、0.25례환자중유23례사용섭저경천막입로,술중소견교정맥여허의연구중문합.결론 허의현실기술가이정학현시섭저교정맥적해부특점,위중후로요기과종류수술입로선택제공합리의거.
Objective To evaluate the application of virtual reality technology via the subtemporal transtentorial approach by comparing the virtual three-dimensional (3-D) microanatomy of the temporal bridging veins as part of the resection of tumors across the petrosal crest and the actual microanatomy of the temporal bridging veins in surgery.Methods The experiment included two groups:virtual group (25 cases of tumor crossing petrosal crest),and surgery group.Before operation,imaging data of patient heads obtained from computerized tomographic angiography (CTA),and magnetic resonance angiography (MRA)etc.were loaded into the Dextroscope workstation.After co-registration of the different modalities of imaging data and segmentation of the veins,the dissection of temporal bridging veins was simulated.The anatomical simulation of VR was the same as that done by surgeons in actual anatomy.We compared the number of branches of each vein,and the position of the veins in VR lab and in operation.Results Four basic configurations of veins were found:venous lakes running in the tentorium before emptying the sinuses (16％,8 hemispheres),candelabra of veins uniting to form one large drainage (42％,21 hemispheres),single independent draining veins (18％,9 hemispheres) and multiple independent draining veins (24％,12 hemispheres) in virtual group,and 10 (43.47％),10(43.47％),4 (17.39％) and 6 (26.08％) in surgery group,respectively.The distributions of anatomical terminations of temporal bridging veins were divided into three groups:transverse area (54.35％,50),tentorium area (23.91％,22) and petrosal area (21.74％,20) in virtual group,and 53.33％ (24),26.67％ (12),and 9 (20％) in surgery groupm respectively.The distance from the emptying point of the labbé veins to the sigmoid transverse point was (20.12±2.51) mm,and the proportion of fore-placed type veins of labbé was 8.33％ in virtual group,and that was (24.12 ±3.68) mm,and 0 in surgery group respectively.The anatomical features of labbé veins found during the operation of the 23 patients with tumors extended from middle fossa to posterior fossa and were identical to those seen in presurgical planning.Conclusion Virtual reality technology can accurately simulate the anatomical feature of temporal bridging veins,which facilitates the planning of individual operations in neurosurgery.