Objective To provide a new method for predicting hematoma expansion in cerebral hemorrhage (ICH). Methods Initial CT scan images of 128 patients with spontaneous intracerebral hematoma were analyzed. Hematoma volumes were measured using the ABC/2 method and 3D Slicer. The difference of hematoma volume was calculated to predict hematoma expansion, and its predictive efficiency was compared with that of hematoma shape categories (hematoma expansion≥6.0 cm3 growth;≥12.5 cm3 growth). Results The hematoma volume initially measured using the ABC/2 method and 3D Slicer was (21.4±16.4) cm3 and (17.7±14.0) cm3, respectively. The hematoma volume measured by the ABC/2 method was significantly larger than that using 3D Slicer (t=11.869, P<0.001). The volume of ICH hematoma measured by the ABC/2 method [(26.3±21.8) ml] at the second CT scan was significantly larger than that at the first scan [(21.4±16.4) ml, t=8.599, P<0.001]. The difference of ICH hematoma volume measured using the ABC/2 method and 3D Slicer was correlated with regular (r=0.628, P<0.05), irregular (r=0.603, P<0.05), and multiple lobular hematoma expansion (r=0.591, P<0.05). The areas under the curve of hematoma volume difference between ABC/2 and 3D Slicer at the first scan for predicting hematoma expansion ≥6.0 cm3 and ≥12.5 cm3 were both greater than those of hematoma shape category (0.866 vs 0.755, Z=2.496, P=0.013; 0.911 vs 0.731, Z=2.674, P=0.008). Conclusion Compared to hematoma shape category, the difference of hematoma volume measured using ABC/2 and 3D slicer could better predict the hematoma expansion. Key words: Intracerebral hemorrhage; Hematoma expansion; Hematoma shape category; 3D Slicer

两年来,李大爷总觉得牙痛,他多次到医院口腔科就诊,甚至拔了几颗牙,牙痛的毛病却总不见好.近日,他到省城的大医院就诊,被诊断为三叉神经痛.原来,他长期牙痛是三叉神经痛惹的祸.临床上,像李大爷这样错把三叉神经痛当成牙痛的不在少数. 三叉神经痛是发生在头部三叉神经的一种慢性疼痛.其特征是剧烈、间断发作、突然的烧灼般或电击样面部疼痛,每次发作持续时间数秒至2分钟不等,而后迅速缓解.这种剧烈的疼痛常让人难以忍受,可给患者造成严重的生理和心理影响.

Objective To compare the three-dimensional anatomic differences of far lateral approach versus presigmoidal approach to expose inferior clivus by virtual reality technique. Methods CT and MRI image data of 15 cadaver heads (30 sides) were inputted into Vitrea virtual reality system to establish three-dimensional anatomy model of posterior cranial fossa. Three points including anterior edges of bilateral tubercula jugulare and tubercula pharyngeum were selected to form a plane. The region of inferior clivus was defined as area under the aforementioned plane. The anterior edge of intersection curve between the plane and the clivus was selected as skull base landmark to expose. The mastoidale and posterior edge of occipital condyle articular surface were selected as craniotomy landmarks of presigmoidal and far lateral approaches. Cylinder with 1 cm diameter was outlined to simulate surgical approach, of which the axis passed through the aforementioned craniotomy landmarks. The superior edge of bottom surface of cylinder on the side of skull base was located in the aforementioned landmark of skull base. Anatomic exposures of the above two approaches were compared by paired t test. Results The far lateral approach located at the lateral edge of foramen magnum, anterior to the cerebellum, lateral to the brain stem, medial to the jugular bulb, lateral and inferior to the accessory nerve, involved hypoglossal nerve and reached inferior clivus. Bone drilling through presigmoidal approach began with mastoidale. The approach passed through inferior edge of jugular bulb, anterior to the sigmoid sinus, inferior to the accessory nerve, involved hypoglossal nerve at the lateral edge of foramen magnum, reached inferior clivus anterior to the brain stem. The volumes of surgical route [(4629.80 ± 81.00) mm3 vs. (2622.60 ± 72.58) mm3; t = 91.532, P = 0.000] and route involving hypoglossal nerve [(10.15 ± 0.17) mm3 vs. (7.15 ± 0.20) mm3; t = 52.413, P = 0.000] through presigmoidal approach were more than those through far lateral approach. Osseous structures involved in far lateral approach was more than that in presigmoidal approach [(2362.90 ± 80.18) mm3 vs. (1851.60 ± 63.62) mm3; t = 25.714, P = 0.000]. Conclusions Passing through hypoglossal nerve and drilling partial osseous structures will help to avoid cerebellum and brain stem and expose inferior clivus through far lateral approach and presigmoidal approach. DOI: 10.3969/j.issn.1672-6731.2017.12.008

Objective To compare microanatomy feature for exposing geniculate ganglion between presigmoidal and retrosigmoidal minimally invasive approaches by virtual reality technique .Methods CT and MRI scans were performed to 15 adult cadaver heads ,then image data was inputted into virtual real‐ity system to establish three -dimensional anatomy model of temporal bone .Surgical routes of presig‐moidal and retrosigmoidal approaches exposing geniculate ganglion were outlined by selecting osseous landmark points on the calvaria and skull base .Special form and sequence of anatomic structures were observed .Volumes of anatomic tissues were measured .Statistical comparison was launched by paired t test .Results Bone drilling through presigmoidal approach started with mastoid and avoided injury of sigmoid sinus and jugular bulb .The surgical route involved vertical segment of facial nerve ,ossicular chain ,labyrinth ,and then ,exposed facial nerve when arrived at geniculate ganglion .Routes simulating sigmoidal approach passed below the transverse sinus and lateral to cerebellum .When arrived at internal acoustic meatus ,the route performed bone drilling for petrous bone and involved facial -acoustic nerve complex .When reached geniculate ganglion ,the ossicular chain and labyrinth were exposed in the route . Measuring showed that the volumes of surgical route and labyrinth were larger in retrosigmoidal ap‐proach than those in presigmoidal approach .Volumes of facial -acoustic nerve complex and ossicular chain were larger in presigmoidal approach than those in retrosigmoidal approach .All above differences reached statistical significance (P < 0 .05) . Volume of cerebellum in retrosigmoidal approach was (462.72 ± 20 .87) mm3 .Presigmoidal approach did not involve cerebellum .NO significant differences were found in the volumes of osseous structures (not include ossicular chain ) between two approaches (P > 0 .05) .Conclusions To expose geniculate ganglion by petrous bone drilling ,presig‐moidal approach is helpful to reduce the injury of labyrinth .Retrosigmoidal approach is helpful to reduce the injury of ossicular chain and expose facial -acoustic nerve complex .

目的 通过应用支持向量机模型预测脑出血患者早期预后转归. 方法 收集自发性脑出血患者310例,随访观察1个月的临床转归情况.将入组患者按时间顺序以3∶1的比例分为数据训练组和验证组,训练组作为训练样本,用于筛选变量和建立预测模型,计232例;验证组作为验证样本,用于评价模型预测效果,计78例. 结果 通过支持向量机模型对78例脑出血患者的预测判别验证,支持向量机的预测准确度76.9％,敏感度77.3％,95％可信区间54.6％-92.2％,特异度76.8％,95％可信区间63.6％-87.0％. 结论 采用支持向量机模型能较好地判断自发脑出血患者早期预后.

目的 在构建虚拟现实解剖模型基础上探讨枕下乙状窦后入路微创磨除内听道的显微解剖证据.方法 15例尸体头颅行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建内听道及其周围结构的三维解剖模型.在颅盖和颅底中选择骨性标志点设计枕下乙状窦后入路磨除内听道内不同靶点的微创路径,观察测量和比较伴随路径方向和角度改变,其中解剖结构的显露情况.结果 模拟枕下乙状窦后入路磨除内听道的手术路径中清晰显示所包含的神经、血管等解剖结构的空间层叠顺序.测量和比较显示路径中骨性结构和迷路体积:路径a＞路径b＞路径c;路径中小脑半球体积:路径b＞路径c＞路径a;路径中面听神经复合体体积:路径b＞路径a＞路径c;差异均有统计学意义.结论 在计算机虚拟现实条件下,乙状窦后入路通过磨除岩骨到达内听道末端的模拟微创手术路径能够有效量化手术创伤和靶点显露情况,为手术操作的微创化发展提供指导信息.

Objective To perform quantitative comparison of microanatomical features between subtemporal and presigmoidal minimally invasive approaches for exposing petrous apex on the basis of virtual reality image model. Methods CT and MRI were performed on 15 adult cadaver heads (30 sides) to establish virtual reality three-dimensional anatomical model of petrous apex. The superior edge of the root of temporal bone zygomatic process and the mastoidale on the calvaria were selected as landmark points of craniotomy through subtempral and presigmoidal approaches. Petrous apex was selected as exposure landmark point on the skull base. The lines between craniotomy and exposure landmark points were used as axis to outline a cylinder simulating surgical routes of subtemporal and presigmoidal approaches. Anatomical exposures in two surgical routes were observed and measured. Statistical comparison was launched by paired t test. Results Surgical route of subtemporal approach passed through middle skull base and temporal lobe, and then reached petrous apex. Petrous bone drilling was performed to expose internal acoustic meatus, facial nerve and labyrinth. Then, trigeminal nerve, superior petrous sinus and cavernous sinus were exposed. Surgical route of presigmoidal approach was performed by drilling petrous bone through mastoid and passing vertical segment of facial nerve. Then, glomus jugulare, the lower cranial nerves, ossicular chain, labyrinth and internal carotid artery (ICA) were exposed in turn. Reaching internal acoustic meatus, the route exposed anterior inferior cerebellar artery (AICA) and facial-acoustic nerve complex. Reaching petrous apex, the route involved superior cerebellar artery, superior petrous sinus, inferior petrous sinus, cavernous sinus, trigeminal nerve and partial temporal lobe. The volumes of route, osseous structures, facial-acoustic complex, labyrinth and vein involved in presigmoidal approach were more than those in subtemporal approach (P = 0.000, for all). Volumes of temporal lobe, trigeminal nerve and ossicular chain involved in subtemporal approach were more than those in presigmoidal approach (P = 0.000, for all). Volume of lower cranial nerve and artery involved in presigmoidal approach was (32.38 ± 2.86) mm3 and (262.74 ± 16.93) mm3 respectively, but above structures were not involved in subtemporal approach. Conclusions Exposure of structures in and around petrous bone in presigmoidal approach is more than that in subtemporal approach. Thus, more attention should be paid to protect critical structures in presigmoidal approach. Subtemporal approach can reach petrous apex through temporal lobe, thus it is suitable to treat lesions in middle skull base which implicate petrous bone and push temporal lobe upward. DOI: 10.3969/j.issn.1672-6731.2016.07.008

目的 在虚拟现实解剖建模基础上,探讨实现经枕髁显露颈静脉结节的路径微创化可行性.方法 15例尸体头颅CT和MRI数据构建颈静脉孔区三维解剖模型,在颅盖和颅底选择骨性标志点,设计经枕髁显露颈静脉结节的手术路径.观察和测量路径体积改变后解剖结构显露情况.结果 手术路径微创化前后均从脑干外侧、小脑半球腹侧和颈静脉球内侧经过.微创化前手术路径依次显露椎动脉、后组脑神经和颈静脉球,在颈静脉球内侧下方显露舌下神经,在后组脑神经上方显露小脑前下动脉.微创化后手术路径从舌咽神经下方穿过,包含部分迷走神经、副神经、舌下神经、小脑前下动脉和岩下窦.测量手术路径、路径中骨性结构、后组脑神经和静脉的体积:微创化前＞微创化后,差异均有统计学意义(P＜0.05).微创化前后手术路径中,小脑前下动脉体积差异无统计学意义.结论 经枕髁显露颈静脉结节的微创化手术路径能够减少骨性结构磨除以及对后组脑神经和静脉损伤,同时不影响对小脑前下动脉显露.

Objective To analyze the risk factors for prognosis in intracerebral hemorrhage using decision tree (classification and regression tree, CART) model and logistic regression model. Methods CART model and logistic regression model were established according to the risk factors for prognosis of patients with cerebral hemorrhage. The differences in the results were compared between the two methods. Results Logistic regression analyses showed that hematoma volume (OR-value 0.953), initial Glasgow Coma Scale (GCS) score (OR-value 1.210), pulmonary infection (OR-value 0.295), and basal ganglia hemorrhage (OR-value 0.336) were the risk factors for the prognosis of cerebral hemorrhage. The results of CART analysis showed that volume of hematoma and initial GCS score were the main factors affecting the prognosis of cerebral hemorrhage. The effects of two models on the prognosis of cerebral hemorrhage were similar (Z-value 0.402, P=0.688). Conclusions CART model has a similar value to that of logistic model in judging the prognosis of cerebral hemorrhage, and it is characterized by using transactional analysis between the risk factors, and it is more intuitive. DOI: 10.11855/j.issn.0577-7402.2015.12.13

Objective To compare microanatomical features of surgery via pterional approach versus subtemporal approach for amygdala resection based on virtual reality image model. Methods Imaging data of 15 adult cadaver heads (30 sides) was inputted into virtual reality system to establish three-dimensional anatomical model of the temporal lobe and surrounding structures. Transpterional approach and subtemporal approach exposing amygdala were simulated by drawing cylinder. Anatomical exposures were observed, measured and compared following change of surgical trajectory. Results The volumes of brain, middle cerebral artery, sphenoparietal sinus via pterional approach were exposed at the anterior edge of amygdala more than at the posterior edge, but the volume of the route exposure was less at the anterior edge than at the posterior edge. The volumes of the route and brain had more exposure at the anterior edge of the amygdala than at the posterior edge in subtemporal approach, while the volumes of the route and brain had more exposure via pterional approach than via subtemporal approach for the anterior and posterior edges of the amygdala. The differences of above items reached statistical significance (all P<0.05). Conclusions Virtual reality three-dimensional image model helps to compare surgical exposures and invasions quantitatively between different approaches in exposing amygdala, and provides information for guiding minimally invasive surgery.

Objective To study the clinical,imaging characteristics,surgical treatments and results of spinal tuberculous granuloma.Methods A total of 15 cases of spinal tuberculous granuloma were retrospectively studied.Laminectomy with partial excision of tuberculous granuloma,open spinal dura mater with communication inside and outside the blood supply,and postoperative continued application of anti-TB drugs ≥ 1 year were performed.Results The surgery area covered 1-7 segment,up to the neck pillow,and down to the lumbar segments.The granuloma length was 3-16 cm.The lesions located mainly in extramedullary of subarachnoid cavity,most commonly seen in the lower point of the physiological curvature of the thoracic subarachnoid cavity.The granuloma could be entirely separated from the dura.From the appearance of neurological damage to the surgery,the shortest time was 3 days,the longest time was 1 month.The prognosis of patients with short duration was better than that of those with a long time.Two weeks after surgery,the muscle strength of 2 cases was increased from grade Ⅰ to grade Ⅳ and the Frankel classification changed from C to D-E.The muscle strength of 13 cases was increased from grade Ⅱ to grade Ⅳ,and the Frankel classification changed from C to D.The follow-up duration was from 1 month to 3 years.Varying degrees of neurological recovery were observed in all the patients.After two months,the MRI of 11 cases showed disappearance of granulomas around the surgical area.After six months,the MRI of 9 cases showed that the granulomas of surgical and non-surgical areas were completely disappeared.Conclusion Surgical decompression could improve the prognosis of spinal tuberculous granuloma.After neurological damage occurred,the sooner the surgery performed,the better the prognosis.

Objective To construct three-dimensional anatomical model of petrous apex virtual reality and discuss the minimally invasive strategy for exposure of petrous apex through subtemporal ap‐proach .Methods Obtaining image data from 15 cases of cadaver heads with head CT and MRI scanning , which was used to establish model in the virtual reality system .Osseous landmark points on the calvaria and skull base were selected to simulate subtemporal approach for exposure of petrous apex .Minimally invasive design was performed by reducing the volume of approach .Changes of anatomy exposures were observed ,measured and compared following minimally invasive design .Results Virtual reality model could clearly show bone and neurovascular structures as subtemporal approach for exposure of petrous a‐pex .Following minimally invasive design ,volumes of surgical route a ,b ,c and osseous structures , temporal lobe ,trigeminal nerve and vein decreased gradually .Volumes of facial -acoustic nerve com‐plex ,greater superficial petrous nerve and labyrinth in road a were more than those in road b .There differences were statistically significant (P< 0 .01) .The differences of above items reached statistical significance .Petrous segment of internal carotid artery only displayed in road a .Conclusions During the minimally invasive design of subtemporal approach exposing petrous apex ,computed virtual reality skill can provide quantitative and objective data .When fixing the approach direction ,narrow path leading to surgical trauma and targets shrunk ,providing guidance for the minimally invasive surgery .

Objective To compare the value of back propagation( BP) neural network versus multiple linear regression for predicting the hospitalized stay in patients with intracerebral hemorrhage( ICH) . Methods Clinical data of patients with ICH were collected in 309th Hospital of Chinese PLA from January 2011 to May 2014. SPSS19. 0 software was applied to analyze the length of hospitalization predicted by BP neural network and multiple linear regression. R,R2 ,adjusted R2,standard error and average relative error were used in evaluation of the two models. Results Predictive values for the hospitalized stay were R2=0. 484 and adjusted R2 =0. 483 by BP neural network, and R2 =0. 467 and adjusted R2=0. 460 for multiple linear regression. The predicting performance of BP neural net-work was better than that of multiple linear regression(t=4. 099,P<0. 001). The standard error was 7. 188 for BP neural network and 7. 389 for multiple linear regressions, and the average relative error was 36. 810% and 37. 101%, respectively. Conclusion The predictive performance of BP neural network is better than that of multiple linear regressions, and it has a reference value for the clini-cal pathway of intracerebral hemorrhage.

目的 在虚拟现实系统中探讨乙状窦前入路显露脑干腹侧的微创手术路径解剖特征.方法 对15例尸体头颅行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建颈静脉孔区三维解剖模型,选择骨性结构和颅神经出脑干处的标志点绘制圆柱模拟经岩骨乙状窦前入路显露脑干腹侧的手术路径,观察测量和比较显露脑干腹侧不同部位的路径中解剖结构空间构筑情况.结果 模拟经岩骨乙状窦前入路显露脑干腹侧的路径中清晰显示所包含的神经、血管等解剖结构的空间层叠顺序,三维影像模型中所测路径中岩骨骨性结构体积:路径b＞路径c＞路径a,后组颅神经体积:路径c＞路径b＞路径a,路径a中包含静脉和小脑前下动脉体积最大,面听神经复合体体积:路径b＞路径a,面神经垂直段体积:路径c＞路径a,差异均有统计学意义(P＜0.05).路径中迷路体积路径b和路径c比较差异无统计学意义(P＞0.05).结论 虚拟现实系统有助于理解乙状窦前入路显露脑干腹侧不同靶点时途径骨性结构、神经、血管等的空间构筑关系.

Objective To study predicting results of the back propagation (BP)neural network model for hematoma enlargement (HE)in patients with intracerebral hemorrhage. Methods The clinical data of 128 patients with cerebral hemorrhage admitted to the 309th hospital of People′s Liberation Army from January 2011 to December 2014 were analyzed retrospectively. The Matlab 7. 14 software was used to achieve BP neural network model for predicting hematoma enlargement within 24 hours in patients with intracerebral hemorrhage (HE ≥6. 0 ml and HE ≥12. 5 ml). The mean square error (MSE)of the model and the accuracy of the overall prediction were calculated. The receiver operation characteristic (ROC) curve was drawn for predicting HE. Results When the BP neural network predicted HE ≥6. 0 ml and HE ≥12. 5 ml,the mean square deviations of the training set,validation set,and test set were 0. 061, 0. 143,0. 052 and 0. 023,0. 057,and 0. 065,respectively. The best fitting performance verification of hematoma enlargement was as follows:≥ 6. 0 ml for network training 11 times and the error value 0. 224;≥12. 5 ml for network training 20 times,and the error value 0. 057. The overall accuracies of predicting HE ≥6. 0 ml and HE ≥12. 5 ml were 92. 2% (118/ 128)and 96. 9% (124/ 128)respectively. Conclusion The BP neural network model have no special limitation for data. It can accurately fit the hematoma expansion model of cerebral hemorrhage.

Objective To discuss microanatomy features of facial-acoustic nerve complex in suboccipito-retrosigmoidal minimally invasive approach based on virtual reality image model. Methods CT and MRI scans were performed to 5 adult cadaver heads, and then, image data was inputted into Vitrea virtual reality system to establish three-dimensional anatomy model of facial-acoustic nerve complex. Suboccipito-retrosigmoidal approach was simulated by selecting osseous landmark points on the calvaria and skull base. Anatomic exposures in surgical trajectory were observed and measured following minimally invasive design. Statistical comparison was launched by paired t test. Results Routes simulating suboccipito-retrosigmoidal approach for exposure of facial-acoustic nerve complex passed under the inferior edge of transverse sinus. Spacial sequence of nerves and vessels in the route was displayed clearly. Vertebral artery and posterior inferior cerebellar artery did not show in the route. Cerebella, lower cranial nerves, anterior inferior cerebellar artery, facial-acoustic nerve complex were exposed successively in route before minimally invasive design. Then, lower cranial nerves pierced the jugular foramen at the site between the jugular bulb and inferior petrosal sinus. Minimally invasive route was higher than that before minimally invasive design and involved cerebella, anterior inferior cerebellar artery and facial-acoustic nerve complex successively. Lower cranial nerves and jugular bulb were not shown in minimally invasive route. Measure and comparative analysis showed that volumes of route (t = 36.331, P = 0.000) and cerebella (t = 16.775, P = 0.000) involved before minimally invasive design were more than that after minimally invasive design with statistically significant difference. Comparison did not show significant differences for the volumes of facial-acoustic nerve complex (t = 1.680, P = 0.127) and anterior inferior cerebellar artery (t = 1.278, P = 0.233) between routes before and after minimally invasive design. Conclusions Minimally invasive routes of suboccipito-retrosigmoidal approach can reduce surgical injury without sacrifice of anatomic exposure for facial-acoustic nerve complex. doi: 10.3969/j.issn.1672-6731.2014.06.008

目的 在构建虚拟现实解剖模型基础上探讨枕下乙状窦后入路微创显露颈静脉孔区的显微解剖特征.方法 5例尸体头颅行CT和MRI扫描,影像数据输入虚拟现实系统构建面听神经复合体三维解剖模型,在颅盖和颅底中选择骨性标志点设计枕下乙状窦后入路路径,观察和测量路径微创化前后对颈静脉孔区的显露情况,并进行比较分析.结果 模拟枕下乙状窦后入路显露颈静脉孔区的路径均由横窦下方穿过,路径中清晰显示所包含的神经、血管等解剖结构的空间层叠顺序,均不包含椎动脉和小脑后下动脉.微创化后手术路径不包含面听神经复合体和小脑前下动脉.通过测量和比较分析,手术路径体积和路径中小脑半球体积:微创化后较微创化前明显减小,差异均有统计学意义(t分别为36.331,16.775;P＜0.01);路径中显露后组颅神经的体积:微创化前后差异无统计学意义(t=0.021,P=0.984).结论 枕下乙状窦后入路微创化手术路径有助于在颈静脉孔区的解剖显露中减少对重要神经血管结构的损伤.

Objective To evaluate curative effect of microvascular decompression for hemifacial spasm under the direction of virtual reality preoperative plans to observe the relation between responding vessel and facialacoustic nerve complex.Methods CT angiography and head MRI scans were performed in 33 cases suffering hemifacial spasm.Image data was putted into Vitrea virtual reality system to reconstruct and simulate exposure of facial-acoustic nerve complex through suboccipito-retrosigmoidal approach.Spatial relationship between responding vessel and facial nerve was identified to direct microvascular decompression.Patients without preoperative plans were enrolled as control group.Results Visualization effects of spatial relation between facial nerve and responding vessels were good.Anterior inferior cerebellar artery was identified as a responding vessel for all cases in two groups.Cohen grade zero in two groups were different with statistical significance [100.0％ (33 cases)vs 85.2％ (23 cases)] (P =0.036).Statistical significance was not shown regarding incidence of complication [0 vs 11.1％ (3 cases)] (P =0.085).Conclusion Virtual reality preoperative plan is helpful for displaying spatial relation between facial nerve and responding vessel clearly and objectively,which ensures safe and effective results.

目的 在构建虚拟现实模型的基础上探讨经枕髁入路显露颈静脉结节的不同手术路径中包含结构的显微解剖特征.方法 15例尸体头颅行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建颈静脉孔区三维解剖模型,在颅盖和颅底中选择骨性标志点设计经枕髁入路显露颈静脉结节的手术路径,观察和测量路径方向改变后解剖结构显露情况,采用方差分析和配对t检验进行数据分析比较.结果 模拟手术路径有效体现随操作方向和角度变化所包含的神经、血管等解剖结构变化,仅路径b包含外展神经,仅路径c包含脑干.路径中骨性结构体积:路径a＞路径c＞路径b;静脉体积:路径b＞路径a＞路径c;小脑前下动脉体积:路径b＞路径c＞路径a;后组颅神经(不包括舌下神经)和舌下神经体积:路径c＞路径a＞路径b;椎动脉体积:路径c＞路径a;小脑体积:路径b＞路径c;差异均有统计学意义.结论 在限定靶点的情况下,围绕枕髁的手术路径方向和角度变化,路径中显露解剖结构随之改变;量化结果可为手术微创化提供信息.

目的 在构建虚拟现实解剖模型基础上探讨枕下乙状窦后入路微创显露颈静脉孔区的显微解剖特征.方法 15例尸体头颅行头颅CT和MRI扫描,影像数据输入虚拟现实系统构建颈静脉孔区三维解剖模型,在颅盖和颅底中选择骨性标志点设计枕下乙状窦后入路的不同微创路径,观察测量和比较伴随微创手术路径改变后解剖结构显露情况.结果 模拟枕下乙状窦后入路显露颈静脉孔区的路径均由横窦下方穿过,路径中清晰显示所包含的神经、血管等解剖结构的空间层叠顺序,均不包含椎动脉和小脑后下动脉.路径a中不包含后组颅神经.路径b均不显露面听神经复合体,3例路径b中不显露小脑前下动脉.路径c不显露面听神经复合体、小脑前下动脉和后组颅神经.测量和比较显示手术路径体积和路径中小脑半球体积:路径b＞路径a＞路径c,路径中显露小脑前下动脉的体积:路径a＞路径b,差异均有统计学意义(P＜0.01).结论 枕下乙状窦后入路的不同微创化手术路径能够有效显露颈静脉孔区的不同靶点,联合使用能够充分发挥各自的优势.