一款医学影像软件在枕下乙状窦后入路相关解剖学测量及精准开颅中的应用

Medical image software in anatomical measurements and precision craniotomy via suboccipital retrosigmoid sinus approach

目的评价一款轻量级医学影像软件——RadiAntⓇ在枕下乙状窦后入路及解剖学测量开颅手术术前规划中的应用。方法选择中山大学附属第三医院神经外科自2020年6月至2021年6月行颅脑CT静脉造影(CTV)的43例住院患者进入研究,其中35例患者CTV数据用于测量星点和乳突切迹起点与横窦乙状窦连接处(TSSJ)空间关系,余8例患者进行枕下乙状窦后入路开颅手术术前规划。记录8例开颅患者开颅时间(以暴露静脉窦缘为准)、静脉窦损伤情况等手术指标及术后2周内并发症发生情况。结果(1)解剖学测量:在左侧,TSSJ位于星点外侧(0.89±0.33)cm,下方(0.63±0.46)cm,两者直线距离为(1.15±0.42)cm;位于乳突切迹起点内侧(0.76±0.49)cm,上方(1.97±0.52)cm,两者直线距离为(2.18±0.49)cm;星点位于表面者占37%,位于横窦上方者占29%,位于下方者占34%。在右侧,TSSJ位于星点外侧(0.88±0.39)cm,下方(0.64±0.43)cm,两者直线距离为(1.12±0.54)cm;位于乳突切迹起点内侧(0.74±0.40)cm,上方(1.93±0.45)cm,两者直线距离为(2.16±0.43)cm;星点位于表面者占40%,位于横窦上方者占26%,位于下方者占34%。(2)术前规划及手术情况:8例手术患者中,关键孔位于星点外侧(0.96±0.49)cm、下方(0.53±0.18)cm,位于乳突切迹起点内侧(0.46±0.35)cm、上方(1.76±0.47)cm;乙状窦内缘位于乳突切迹起点内侧(0.13±0.51)cm、上方(0.21±0.46)cm;横窦下缘位于星点内侧(2.17±0.45)cm、下方(0.53±0.35)cm。手术中所有患者关键孔、横窦下缘及乙状窦内缘均定位准确,骨窗缘距乙状窦内侧缘为(3.5±1.0)mm,开颅时间为(25.7±4.1)min,无静脉窦损伤。术后CT显示骨瓣复位良好,骨质缺损较少。随访2周无脑脊液漏和皮下积液发生。结论利用RadiAntⓇ软件进行三维重建能够低手术成本,快速完成解剖学测量及术前规划,为枕下乙状窦后入路精准开颅提供便利。

Objective To evaluate the application of a medical image software(RadiAnt)in anatomical measurements and precision craniotomy via suboccipital retrosigmoid sinus approach.Methods A total of 43 inpatients who underwent craniocerebral CT venography(CTV)in our hospital from June 2020 to June 2021 were selected for the study;the CTV data of 35 patients was used to measure the spatial relations between transverse sigmoid sinus junction(TSSJ)and asterion;the preoperative planning in suboccipital retrosigmoid sinus craniotomy with the software was performed in the left 8 patients.Craniotomy time(subjected to exposure of venous sinus margin),venous sinus injury and incidence of complications within 2 weeks of craniotomy in these 8 patients were recorded.Results(1)Anatomic measurement:for the left side,TSSJ was located at(0.89±0.33)cm lateral and(0.63±0.46)cm inferior to the asterion,and their direct distance was(1.15±0.42)cm;TSSJ was located at(0.76±0.49)cm interior and(1.97±0.52)cm superior to the starting point of the mastoid notch,and their direct distance was(2.18±0.49)cm;about 29%asterion were located superior to the transverse sinus,37%were located on the surface of the transverse sinus,and 34%were located inferior to the transverse sinus.For the right side,TSSJ was located at(0.88±0.39)cm lateral and(0.64±0.43)cm inferior to the asterion,and their direct distance was(1.12±0.54)cm;TSSJ was located at(0.74±0.40)cm interior and(1.93±0.45)cm superior to the starting point of the mastoid notch,and their direct distance was(2.16±0.43)cm;about 26%asterion were located superior to the transverse sinus,40%were located on the surface of the transverse sinus,and 34%were located inferior to the transverse sinus.(2)Preoperative planning and surgeries:in these 8 patients,the key-hole was located at(0.96±0.49)cm lateral and(0.53±0.18)cm inferior to the asterion,and(0.46±0.35)cm interior and(1.76±0.47)superior to the starting point of mastoid notch.The interior of sigmoid sinus was located(0.13±0.51)cm interior and(0.21±0.46)cm superior to the starting point of mastoid notch.The inferior of the transverse sinus was located(2.17±0.45)cm interior and(0.53±0.35)cm inferior to the asterion.An accurate localization of the real position of TSSJ,inferior of transverse sinus and interior of sigmoid sinus was performed in all 8 surgical patients.The distance between the margin of the bone window and the interior of sigmoid sinus was(3.5±1.0)mm,and the craniotomy time was(25.7±4.1)min;no sinus injury was noted.Post-operative CT showed good reposition of the bone flaps and less bone defect.There was no cerebrospinal fluid leakage or subcutaneous effusion during the 2 weeks of follow-up.Conclusion Anatomical measurements and preoperative planning can be quickly finished with low cost with RadiantⓇ,which provides an efficient and safe method for accurate craniotomy via suboccipital retrosigmoid approach.