Gu Shi-Xin, Yang De-Lin, Cui Da-Ming, Xu Qi-Wu, Che Xiao-Ming, Wu Jin-Song, Li Wen-Sheng
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Clin Neurol Neurosurg. 2011 Dec;113(10):889-94. doi: 10.1016/j.clineuro.2011.06.008. Epub 2011 Aug 9.
To evaluate the application of virtual reality technology in neurosurgical anatomy we compared the virtual three-dimensional (3D) microanatomy of the temporal bridging veins as part of the resection of tumors across the petrosal crest in 25 patients against the actual microanatomy of the temporal bridging veins on 20 cadaveric head sets.
The experiment was carried out by two groups of data: a virtual group made of 25 clinical cases and a physical body group made of 20 cadaveric head sets. In the physical body group, the temporal bridging veins on the cadaveric heads were examined under the microscope from the number of their tributaries to termination and measure the distance between emptying point on sinus of labbé vein and sigmoid transverse sinus. In the virtual group, the dissection of the temporal bridging veins was simulated on Dextroscope. We compared the anatomical features of temporal bridging veins in two groups. Virtual reality technology was used in the planning of 25 cases for which the anatomy of temporal bridging veins needed to be studied carefully by the neurosurgical team.
Four basic configurations of veins were found: venous lakes running in the tentorium before emptying the sinuses 17.5% (7 hemispheres), candelabra of veins uniting to form one large drainage 40% (16 hemispheres), single independent draining veins 20% (8 hemispheres) and multiple independent draining veins 22.5% (9 hemispheres) in physical body group, venous lake16% (8 hemispheres), candelabra of veins uniting to form one large drainage 42% (21 hemispheres), single independent draining veins 18% (9 hemispheres) and multiple independent draining veins 24% (12 hemispheres) in virtual group. 213 tributaries (85 drainage to labbé veins) and 87 terminations of temporal bridging veins were found in cadaveric heads, whereas 167 tributaries (80 to labbé veins) and 81 terminations of temporal bridging veins were found in the virtual group. The distribution of anatomical terminations of temporal bridging veins were divided into three groups: transverse area 52.87% (46) tentorium area 24.13% (21) and petrosal area 23.10% (20) in physical body group, whereas 54.35% (50) 23.91% (22) and 21.74% (20) in virtual group, respectively. The proportion of fore-placed type veins of labbé is 7.69% in physical body group and 8.33% in virtual group (P>0.05). The distance from the emptying point of the labbé veins to the sigmoid transverse point in the virtual group was 18.75 ± 1.95 mm, in the physical body group was 20.12 ± 2.51 mm (P>0.05). The anatomical features of labbé veins found during the operation of the 25 patients with tumors extended from middle fossa to posterior fossa and were identical to what was seen in presurgical planning.
Virtual reality technology can accurately simulate the anatomical feature of the temporal bridging veins which facilitates the planning of individual operations in neurosurgery.
为评估虚拟现实技术在神经外科解剖学中的应用，我们将25例经岩嵴切除肿瘤患者颞桥静脉的虚拟三维（3D）微观解剖结构，与20个尸体头颅标本上颞桥静脉的实际微观解剖结构进行了比较。
实验由两组数据组成：一组为25例临床病例的虚拟组，另一组为20个尸体头颅标本的实体组。在实体组中，在显微镜下检查尸体头颅上的颞桥静脉，从其分支数量到终止情况，并测量Labbe静脉在窦上的排空点与乙状窦横窦之间的距离。在虚拟组中，在Dextroscope上模拟颞桥静脉的解剖。我们比较了两组颞桥静脉的解剖特征。虚拟现实技术用于25例需要神经外科团队仔细研究颞桥静脉解剖结构的病例的手术规划。
在实体组中发现静脉有四种基本构型：在汇入窦之前走行于小脑幕的静脉湖占17.5%（7个半球），静脉分支联合形成一条大引流静脉的烛台状占40%（16个半球），单一独立引流静脉占20%（8个半球），多条独立引流静脉占22.5%（9个半球）；在虚拟组中，静脉湖占16%（8个半球），静脉分支联合形成一条大引流静脉的烛台状占42%（21个半球），单一独立引流静脉占18%（9个半球），多条独立引流静脉占24%（12个半球）。在尸体头颅上发现213条颞桥静脉分支（85条引流至Labbe静脉）和87个终止点，而在虚拟组中发现167条分支（80条引流至Labbe静脉）和81个终止点。颞桥静脉解剖终止点的分布分为三组：实体组中横窦区占52.87%（46个）、小脑幕区占24.13%（21个）、岩骨区占23.10%（20个），虚拟组中分别为54.35%（50个）、23.91%（22个）和21.74%（20个）。实体组中Labbe静脉前置型静脉的比例为7.69%，虚拟组中为8.33%（P>0.05）。虚拟组中Labbe静脉排空点至乙状窦横窦点的距离为18.75±1.95mm，实体组中为20.12±2.51mm（P>0.05）。25例肿瘤从颅中窝延伸至颅后窝患者手术中发现的Labbe静脉解剖特征与术前规划所见一致。
虚拟现实技术能够准确模拟颞桥静脉的解剖特征，有助于神经外科个性化手术的规划。
