Dzierzanowski J, Słoniewski P, Rut M
Department of Neurosurgery, Medical University of Gdansk, Poland.
Folia Morphol (Warsz). 2008 Nov;67(4):267-72.
Much attention has been paid in the neurosurgical literature to optimising the approaches to intracranial pathology. The aims of the innovations reported are to increase the safety of operations by reduction of brain retraction and to improve exposure of the neurovascular structure in the operating area. It was our intention to investigate whether an image-guided frameless stereotactic system is suitable in morphometric studies based on the analysis of the pterional and the cranio-orbitozygomatic approaches to the basilar artery bifurcation (BAB). We analysed 60 virtual models of pterional craniotomy and the same number of those extended by orbitozygomatic osteotomy, created using computer tomography in the neuronavigation system. It was decided to calculate the percentage change of the cranial area of exposure, the depth of the surgical corridor and the angle of view to the bifurcation of the basilar artery. Three positions of the BAB (normal, high and low) were examined for each model of craniotomy. In the material analysed, after the extension of the pterional craniotomy by orbitozygomatic osteotomy, the cranial area of exposure for 60 models of cranio-orbitozygomatic craniotomies increased by a mean of 39.28% (from 30.89% to 48.06%). The decrease in the depth of the surgical corridor for a normal-lying BAB was 19.16%, for a high-lying BAB 19.09% and for a low-lying BAB 19.12%. The mean changes in the individual BAB locations did not differ significantly in statistical terms (F = 0.011; p = 0.99). The mean increase in the cranial angle of attack for a normally located BAB was 10.72 degrees , for a high-lying BAB 11.1 degrees and for a low-lying BAB 10.31 degrees . The post-hoc test showed significant differences in the angle of attack between a normal and a low-lying BAB (p = 0.034) and a high and a low-lying BAB (p = 0.00007). Neuronavigation systems, already well-known for their intraoperative use, can also be useful in morphometric studies, and the advantages of this method are the practically unlimited number of results which can be analysed in detail and the repeatability of the technique. The pterional-orbitozygomatic approach compared to the pterional increases the working area, minimises retraction of the brain, shortens the working distance, enables instruments to be used more easily, widens the angle of view and improves the visibility of the anatomical structures in the working area, especially for a high-lying BAB.
神经外科文献中已对优化颅内病变的手术入路给予了大量关注。所报道创新的目的是通过减少脑牵拉来提高手术安全性，并改善手术区域神经血管结构的暴露。我们的目的是基于对翼点入路和颅眶颧入路至基底动脉分叉（BAB）的分析，研究图像引导无框架立体定向系统是否适用于形态学研究。我们分析了60个翼点开颅术的虚拟模型以及同样数量通过眶颧截骨术扩展的模型，这些模型是在神经导航系统中利用计算机断层扫描创建的。我们决定计算颅骨暴露面积的百分比变化、手术通道的深度以及至基底动脉分叉处的视角。对每种开颅术模型检查了BAB的三个位置（正常、高位和低位）。在所分析的材料中，翼点开颅术经眶颧截骨术扩展后，60个颅眶颧开颅术模型的颅骨暴露面积平均增加了39.28%（从30.89%增至48.06%）。对于位置正常的BAB，手术通道深度减少了19.16%，对于高位BAB减少了19.09%，对于低位BAB减少了19.12%。在统计学上，各个BAB位置的平均变化差异不显著（F = 0.011；p = 0.99）。对于位置正常的BAB，颅骨攻击角度平均增加10.72度，对于高位BAB增加11.1度，对于低位BAB增加10.31度。事后检验显示，正常位置与低位BAB之间（p = 0.034）以及高位与低位BAB之间（p = 0.00007）的攻击角度存在显著差异。神经导航系统因其术中应用已广为人知，在形态学研究中也可能有用，该方法的优点是可详细分析的结果数量实际上不受限制且技术具有可重复性。与翼点入路相比，翼点 - 眶颧入路增加了工作区域，使脑牵拉最小化，缩短了工作距离，便于器械使用，拓宽了视角并改善了工作区域内解剖结构的可视性，尤其是对于高位BAB。
