虚拟现实技术在远外侧入路探查枕骨大孔前部中的应用分析

Anatomical analyses of far lateral approach exposing anterior part of the foramen magnum in virtual reality system

目的在通过虚拟现实技术构建的三维解剖模型中分析远外侧入路不同操作轨迹与枕骨大孔前部的解剖显露之间的数据关系。方法回顾性收集解放军总医院和天坛医院神经外科自2015年9月至2019年1月收治的50例三叉神经痛患者的多模态影像资料并输入虚拟现实系统构建后颅窝三维解剖模型。选取枕髁关节面后缘作为远外侧入路开颅起始点,在颅底骨性结构中分别选择同侧舌下神经管开口、颈静脉结节前缘和枕骨大孔前缘作为暴露目标,以开颅起始点与3个暴露目标之间连线为轴线做出一个半径为5 mm的圆柱模拟远外侧入路显露枕骨大孔前部的手术路径,路径按1、2、3依次命名。观察不同路径操作空间大小,记录每种路径经过某种解剖组织的频数并测量解剖结构的体积。结果3种路径操作空间体积、经过的骨性结构和后组颅神经体积差异均有统计学意义(P<0.05);其中路径3操作空间体积较路径1、2明显增大,路径2经过的骨性结构和后组颅神经体积较路径1、3明显增大,差异均有统计学意义(P<0.05)。结论在虚拟现实技术模拟的远外侧入路中采集数据有助于揭示路径操作空间中解剖关系,为选择最佳手术路径提供依据。

Objective To analyze the anatomical relations between operating spaces of different paths via far lateral approach and exposure of the anterior part of the foramen magnum based on data of virtual reality three-dimensional model.Methods The CT and MRI images of 50 patients with trigeminal neuralgia,admitted to our hospital from September 2015 to January 2019 were extracted from Gamma Knife databases and inputted into Vitrea virtual reality system to establish a three-dimensional anatomy model of the posterior cranial fossa.Posterior margin of the articular surface of occipital condyle was selected as starting point to open the skull via far lateral approach;the ipsilateral sublingual neural tube opening,anterior margin of the jugular tubercle,and anterior margin of the foramen magnum were selected as the exposed targets in the base of skull bony structure;the ligatures between starting point and the 3 exposed targets were used as axis to reveal a radius of 5 mm cylinder to simulate the surgical paths exposed the anterior margin of the foramen magnum via far lateral approach,and these surgical paths were named as Path 1,2 and 3.The operating spaces of different paths were observed,and the frequency of each path passing through certain anatomical tissues was recorded and the volume of anatomical structures was measured.Results There were significant differences in operating space volume,bony structure and volume of lower cranial nerves among the 3 paths(P<0.05).The operating space volume of Path 3 was significantly increased as compared with that of Path 1 and 2,and bony structure and volume of lower cranial nerves of Path 2 were significantly increased as compared with those of Path 1 and 3(P<0.05).Conclusion The data collected in the surgical paths via distal lateral approach simulated by virtual reality technology can help reveal the anatomical relationship in the operating space and provide a basis for selecting the best surgical path.