CAJ | 학술논문

目的在构建虚拟现实解剖模型基础上探讨三叉神经微血管减压术微创化过程中的显微解剖特征. 方法对5例成人尸体头颅行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建桥脑小脑角三维解剖模型,设计枕下乙状窦后入路路径,在三叉神经脑池段分别选择三叉神经入脑干处(a点)、入半月神经节处(b点)以及两者之间中点(c点)为显露靶点.分别以上述a、b、c3个显露靶点为顶点做出圆锥a、b、c,模拟枕下乙状窦后入路显露三叉神经脑池段的3个手术路径,观察和测量这3个路径微创化前后解剖结构显露情况并进行统计比较. 结果模拟枕下乙状窦后入路三叉神经微血管减压术的路径均由横窦下方穿过,路径清晰显示与周围神经、血管的关系.微创化前后a、b、c3个手术路径的测量数据比较结果为:b路径体积＞c路径体积＞a路径体积,a小脑半球体积＞c小脑半球体积＞b小脑半球体积. 结论枕下乙状窦后入路微创化手术路径能够在保证三叉神经微血管减压术解剖显露的情况下减少手术创伤.
목적 재구건허의현실해부모형기출상탐토삼차신경미혈관감압술미창화과정중적현미해부특정. 방법 대5례성인시체두로행두로CT화MRI소묘,영상수거수입허의현실계통구건교뇌소뇌각삼유해부모형,설계침하을상두후입로로경,재삼차신경뇌지단분별선택삼차신경입뇌간처(a점)、입반월신경절처(b점)이급량자지간중점(c점)위현로파점.분별이상술a、b、c3개현로파점위정점주출원추a、b、c,모의침하을상두후입로현로삼차신경뇌지단적3개수술로경,관찰화측량저3개로경미창화전후해부결구현로정황병진행통계비교. 결과 모의침하을상두후입로삼차신경미혈관감압술적로경균유횡두하방천과,로경청석현시여주위신경、혈관적관계.미창화전후a、b、c3개수술로경적측량수거비교결과위:b로경체적＞c로경체적＞a로경체적,a소뇌반구체적＞c소뇌반구체적＞b소뇌반구체적. 결론 침하을상두후입로미창화수술로경능구재보증삼차신경미혈관감압술해부현로적정황하감소수술창상.
Objective To discuss the microanatomy features of microvascular decompression for trigeminal nerve through minimally invasive approach based on virtual reality image models.Methods CT and MRI scans were performed to five adult cadaver heads, and then, image data were inputted into vitrea virtual reality system to establish three-dimensional anatomy models of cerebellopontine angle.Suboccipito-retrosigrmoidal approach was simulated by selecting asterion as osseous landmark points of craniotomy and cistern segment of trigeminal nerve as exposed target.Anatomic exposures in surgical trajectory were observed and measured before and after minimally invasive design, respectively.Results Routes simulating microvascular decompression for trigeminal nerve through suboccipito-retrosigmoidal approach passed under the inferior edge of transverse sinus.Spacial relationship among route and surrounding nerves and vessels were displayed clearly.Measurement and comparative analysis among different routes indicated the volumes of routes: route b＞ route c ＞ route a, and involved cerebellar volumes: route a ＞route c ＞ route b.Conclusion Minimally invasive routes of suboccipito-retrosigmoidal approach can reduce surgical injure without sacrifice of anatomic exposure in microvascular decompression for trigeminal nerve.