三维可视化工作站在经鼻蝶内镜手术中的应用

Application of three-dimensional visual neurosurgical station in endonasal transsphenoidal surgery via endonasal neuroendoscopic

目的 探讨三维可视化神经外科工作站在经鼻蝶内镜下鞍区病变切除术中的临床应用价值。方法 神经内镜下经鼻蝶入路鞍区病变切除术患者128例，术前均行常规CT头颈血管成像检查，采用自行研制的神经外科影像与手术操作平台系统（简称神经外科工作站，又称神经外科三维可视化工作站）观察入路相关的骨质、血管、神经与肿瘤的三维空间位置关系，模拟手术操作，并与实际手术操作过程比较。结果 128例患者通过神经外科三维可视化工作站均能清晰显示重要骨质、神经、血管等解剖标志与肿瘤的三维空间的关系。如中鼻甲、骨性鼻中隔、蝶骨嘴、蝶窦开口、蝶窦间隔、颈内动脉隆突、视神经隆突、鞍底、海绵窦或海绵间窦、肿瘤等，术前模拟手术操作与术中实际情况一致。结论 神经外科三维可视化工作站能有效指导神经内镜下经鼻蝶手术术前计划制定，提高手术的可控性、精准性及安全性，减少操作的盲目性及术后并发症，节约手术时间与医疗成本。

Objective To investigate the clinical application value of three-dimensional visualization neurosurgery workstation in the resection of sellar region lesions under nasal endoscope.Methods One hundred and twenty-eight cases of sellar region lesions underwent endoscopic endonasal transsphenoidal approach were selected, CT head and neck angiography was performed routinely before the operation, the neurosurgery image and operation platform system （neurosurgery workstation, neurosurgery 3D visualization workstation） was applied to observe the three-dimensional spatial relationship of bone, blood vessel, nerve and tumor, simulated surgical procedure, and compared with the actual operation process.Results The three-dimensional visualization of the important bone, nerve, blood vessel and the three-dimensional space of the tumor can be clearly displayed in the three-dimensional visualization workstation of the neurosurgery in 128 cases. Such as the middle turbinate, bony nasal septum, sphenoid bone, sphenoidal sinus opening, sphenoidal septum, internal carotid artery carina, optic nerve carina, sellar floor, cavernous sinus or cavernous sinus, tumor and so on, the simulated operation before operation was consistent with the actual situation during the operation.Conclusions The three dimensional visualization neurosurgery workstation can effectively guide the preoperative planning of endoscopic endonasal transsphenoidal surgery, improve the controllability, accuracy and safety of the operation, reduce the blindness and complications after operation, and save operation time and medical cost.