CAJ | 학술논문

目的在构建虚拟现实解剖模型基础上探讨经乙状窦前入路微创手术显露颈静脉孔区的显微解剖特征.方法 15例尸头标本行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建颈静脉孔区三维解剖模型,选择骨性标志点设计经乙状窦前入路分别显露内听道入口上缘(路径a)、颈静脉孔前缘(路径b)和颈静脉孔后缘(路径c)的不同微创手术路径,观察测量并比较伴随微创手术路径改变后解剖结构显露情况的变化.结果在模拟经乙状窦前入路显露颈静脉孔区的手术路径中,可清晰显示所包含的神经、血管等解剖结构的空间层叠顺序,其中路径a位置水平最高,向内上方紧贴半规管和内淋巴囊后方到达面听神经复合体进入内听道处;路径b向内侧紧贴颈静脉球前方到达颈静脉孔神经部;路径c位置水平最低,向内侧紧贴乙状窦前缘到达颈静脉球.在所测手术路径体积和路径中岩骨骨性结构体积比较方面,路径a＞路径b＞路径c;在手术路径中静脉窦体积比较方面,路径b＞路径a＞路径c,差异均有统计学意义(P＜0.05).路径a中显露面听神经复合体的体积为(53.32±5.54) mm3,小脑前下动脉的体积为(30.55±3.51) mm3;路径b中显露后组颅神经的体积为(84.59±9.23) mm3.结论经乙状窦前入路显露颈静脉孔区不同靶点的微创手术路径对骨性结构和静脉窦的影响不同,联合使用各手术路径能够充分发挥各自的优势.
목적 재구건허의현실해부모형기출상탐토경을상두전입로미창수술현로경정맥공구적현미해부특정.방법 15례시두표본행두로CT화MRI소묘,영상수거수입허의현실계통구건경정맥공구삼유해부모형,선택골성표지점설계경을상두전입로분별현로내은도입구상연(로경a)、경정맥공전연(로경b)화경정맥공후연(로경c)적불동미창수술로경,관찰측량병비교반수미창수술로경개변후해부결구현로정황적변화.결과 재모의경을상두전입로현로경정맥공구적수술로경중,가청석현시소포함적신경、혈관등해부결구적공간층첩순서,기중로경a위치수평최고,향내상방긴첩반규관화내림파낭후방도체면은신경복합체진입내은도처;로경b향내측긴첩경정맥구전방도체경정맥공신경부;로경c위치수평최저,향내측긴첩을상두전연도체경정맥구.재소측수술로경체적화로경중암골골성결구체적비교방면,로경a＞로경b＞로경c;재수술로경중정맥두체적비교방면,로경b＞로경a＞로경c,차이균유통계학의의(P＜0.05).로경a중현로면은신경복합체적체적위(53.32±5.54) mm3,소뇌전하동맥적체적위(30.55±3.51) mm3;로경b중현로후조로신경적체적위(84.59±9.23) mm3.결론 경을상두전입로현로경정맥공구불동파점적미창수술로경대골성결구화정맥두적영향불동,연합사용각수술로경능구충분발휘각자적우세.
Objective To discuss the microanatomy features of jugular foramen region in transpetrosal-presigmoidal minimally invasive approach based on virtual reality image models.Methods CT and MRI scans were performed to fifteen adult cadaver heads,and then,imaging data were inputted into Vitrea virtual reality system to establish three-dimensional anatomy models of jugular foramen region.Different minimally invasive transpetrosal-presigrnoidal approaches exposing superior edge of internal acoustic meatus (route A),anterior edge of jugular foramen (route B),and posterior edge of jugular foramen (route C) were simulated by selecting osseous landmark points.Anatomic exposures in surgical trajectory following alternation of minimally invasive approach were observed,measured and compared.Results Spacial sequence of nerves and vessels in the route simulating transpetrosal-presigmoidal approach for exposure of jugular foramen region was displayed clearly;route A had the highest location and route C was the lowest.Volumes of route and petrosal osseous structure involved in route A was the largest,and then,volumes of route and osseous structure involved in route B was larger than those in route C,with significant differences (P＜0.05).Volumes of involved venous sinus were as follow:route B＞route A＞route C,with significant differences (P＜0.05).Volumes of facial-acoustic nerve complex and anterior inferior cerebellar artery involved in route A were (53.32± 5.54) mm3 and (30.55±3.51) mm3,respectively.Volumes of lower cranial nerves involved in route B were (84.59±9.23) mm3.Conclusion There are different impacts on the osseous structures and venous sinus for the minimally invasive routes of transpetrosal-presigmoidal approach exposing different targets,of which combinations are helpful to utilize respective advantages.