Kawase入路操作方向对脑干显露影响的虚拟现实解剖学研究

发布时间：2018-05-02 19:32

本文选题：Kawase入路 + 虚拟现实　；参考：《中国临床解剖学杂志》2017年04期

【摘要】：目的在虚拟现实建模基础上探讨Kawase入路显微解剖特征。方法 15例尸体头颅CT和MRI影像数据用于构建颅底虚拟现实三维解剖模型。以开颅和磨除岩骨的标志点连线为轴线作出圆柱模拟Kawase入路手术路径。观察和测量两种方向手术路径中解剖结构显露情况。结果 Kawase入路路径1包含岩上窦,路径终点为三叉神经出脑干处的脑桥,包含部分三叉神经和小脑上动脉。路径2包含岩上窦、岩下窦和基底窦,之后于脑桥腹侧依次经过同侧三叉神经、同侧展神经、基底动脉、对侧展神经和对侧三叉神经,路径2终点为路径圆柱轴线与对侧三叉神经根的交点。路径2中所测手术路径、路径中骨性结构、脑干、动脉结构、静脉结构、岩浅大神经和同侧三叉神经体积均大于路径1中所测数据,差异有统计学意义。操作方向1和2路径中包含颞叶体积差异无统计学意义。结论 Kawase三角形成一个手术窗口,改变经过窗口的路径方向时,路径操作范围随之改变。经过颞骨颧突根部上缘的路径更有助于显露脑干腹侧。
[Abstract]:Objective to explore the microanatomical features of Kawase approach based on virtual reality modeling. Methods CT and MRI images of 15 cadaveric heads were used to construct virtual reality 3D anatomical model of skull base. Using the line of mark point of craniotomy and petrous bone grinding as axis, the surgical path of Kawase approach was simulated by cylinder. To observe and measure the exposure of anatomical structure in two directions. Results the Kawase pathway 1 contained the superior petrosal sinus, and the end point was the pons of the trigeminal nerve at the brainstem, including part of the trigeminal nerve and the superior cerebellar artery. Route 2 included the superior petrosal sinus, inferior petrosal sinus and basal sinus, and then passed through ipsilateral trigeminal nerve, ipsilateral abductive nerve, basilar artery, contralateral abducent nerve and contralateral trigeminal nerve at the ventral side of the pontine. The end point of path 2 is the intersection of the axis of the path cylinder and the contralateral trigeminal nerve root. The volume of the surgical pathway, the bone structure, the brain stem, the arterial structure, the venous structure, the superficial petrosal nerve and the ipsilateral trigeminal nerve in path 2 were larger than those in path 1. The difference was statistically significant. There was no significant difference in temporal lobe volume between pathways 1 and 2. Conclusion the Kawase triangle forms an operative window. When the path direction is changed, the operating range of the path changes. The pathway through the superior edge of the zygomatic process of the temporal bone is more helpful in exposing the ventral side of the brain stem.
【作者单位】：厦门医学院基础医学系;首都医科大学附属北京天坛医院北京市神经外科研究所;解放军第三O九医院神经外科;
【基金】：首都卫生发展科研专项基金(首发2014-4-5073)
【分类号】：R322;R651.1

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