Department of Neurosurgery, Juntendo University, Shizuoka Hospital, Shizuoka, Japan.
Neurosurgery. 2010 Jun;66(6 Suppl Operative):339-41; discussion341. doi: 10.1227/01.neu.0000369664.24998.b6.
Improved educational tools for anatomic understanding and surgical simulation of the cranial base are needed because of the limited opportunities for cadaver dissection. A 3-dimensional cranial base model with retractable artificial dura mater is essential to simulate the epidural cranial base approach.
We developed our 3-dimensional cranial base model with artificial dura mater, venous sinuses, cavernous sinus, internal carotid artery, and cranial nerves, and the extradural temporopolar approach was simulated using this new model.
This model can be dissected with a surgical drill because of the artificial bone material. The periosteal dura was reconstructed in the medial wall of the cavernous sinus, periorbita, and periosteal bridge in the superior orbital fissure with yellow silicone. The meningeal dura was made with brown silicone. The single-layer dura mater could be dissected from the bone surface and retracted with a surgical spatula.
Extradural drilling of the superior orbital fissure and opening of the optic canal were similar to actual surgery. Extradural anterior clinoidectomy was performed via the extradural space by retracting the artificial dura mater. The artificial dura propria of the lateral wall in the cavernous sinus was successfully peeled from the artificial cranial nerves to complete the extradural temporopolar approach.
The improved 3-dimensional cranial base model provides a useful educational tool for the anatomic understanding and surgical simulation of extradural cranial base surgery.
由于尸体解剖机会有限,因此需要改进解剖学理解和颅底手术模拟的教育工具。具有可伸缩人造硬脑膜的三维颅底模型对于模拟硬膜外颅底入路至关重要。
我们开发了带有人造硬脑膜、静脉窦、海绵窦、颈内动脉和颅神经的三维颅底模型,并使用该新模型模拟了颅外颞极入路。
由于使用了人造骨材料,因此可以用手术钻对该模型进行解剖。通过黄色硅胶在海绵窦、眶骨膜和眶上裂骨膜桥的内侧壁重建硬脑膜,通过棕色硅胶制作脑膜。单层硬脑膜可以从骨表面分离并用手术刮刀缩回。
眶上裂硬膜外钻孔和视神经管开放与实际手术相似。通过缩回人造硬脑膜,在硬膜外空间进行了硬膜外前床突切除术。成功地将外侧壁硬脑膜从人造颅神经上剥离下来,完成了颅外颞极入路。
改进的三维颅底模型为硬膜外颅底手术的解剖学理解和手术模拟提供了有用的教育工具。