增强现实技术辅助CT三维重建在经乙状窦后入路开颅手术中的应用

Application of augmented reality-assisted three-dimensional CT in retrosigmoid craniotomy

目的 探讨增强现实技术辅助颅骨CT三维重建在经乙状窦后入路开颅手术中的应用效果.方法 前瞻性纳入2016年8月至2017年2月宁夏医科大学总医院神经外科收治的32例拟行经乙状窦后入路手术的患者.术前应用颅骨CT三维重建技术进行颅骨重建,于重建图像的颅骨内横窦沟与乙状窦沟结合处下缘模拟出“关键孔”,保存图像数据导入智能手机.术中借助增强现实技术,使含模拟钻孔点的颅骨图像与真实颅骨图像融合,指导“关键孔”的定位.结果 32例患者手术疗效均满意,术中无一例发生静脉窦损伤.通过“关键孔”均清晰显露横窦与乙状窦结合处.结论 对于经乙状窦后入路开颅手术,术前使用CT三维重建模拟“关键孔”的位置,术中通过增强现实技术协助定位,可实现“关键孔”定位个体化,避免静脉窦的损伤.

 Objective To explore the application of augmented reality-assisted three-dimensional （3D） CT in retrosigmoid craniotomy.Methods Thirty-two patients underwent retrosigmoid craniotomy at Department of Neurosurgery,General Hospital of Ningxia Medical University from August 2016 to February 2017 and were enrolled into this prospective study.3D reconstruction of CT skull was performed before operation and a simulative burr-hole was placed on the margin of transverse-sigmoid sinus groove junction on the intemal view of skull in 3D CT image,which was then saved and transferred to the smartphone.To guide the location of ＂key hole＂,the skull image with simulated drilling points was fused with the actual skull image by augmented reality during the operation.Results The treatment outcomes of 32 operations were satisfactory.No damage of venous sinus was reported.The transverse-sigmoid sinus junction was exposed in each key hole.Conclusions Simulation of the ＂key hole＂ position with preoperative 3D CT and its intraoperative localization with augmented reality could avoid the risk of sinus injury and help identify the individual location of the ＂key hole＂ in retrosigmoid craniotomy.