Teixido Michael, Woods Owen, Kung Brian, Seyyedi Mohammad
Christiana Care Health Systems, Newark, DE, USA.
University of Montreal, Canada.
World J Otorhinolaryngol Head Neck Surg. 2016 Mar 19;2(1):1-6. doi: 10.1016/j.wjorl.2016.02.002. eCollection 2016 Mar.
To develop a three-dimensional study tool of the membranous labyrinth in order to study the pathophysiology, diagnostic workup and treatment of benign paroxysmal positional vertigo (BPPV). BPPV is the most common cause of peripheral vertigo. Its diagnosis and treatment depend on an understanding of the anatomy of the vestibular labyrinth and its position relative to the head. To date, many illustrations have been made to explain principals of diagnosis and treatment of BPPV, but few have been based on anatomical studies of the membranous labyrinth.
A cadaveric human membranous labyrinth was axially sectioned at 20 μm resolution, stained and segmented to create a high-resolution digital model. The model was cloned to create an enantiomeric pair of labyrinths. These were associated a 3D model of a human skull, segmented from MRI data, and were oriented according to established anatomic norms. Canal markers representing otoliths were created to mark canalith position during movement of the model within the 3D environment.
The model allows visualization of true membranous labyrinth anatomy in both ears simultaneously. The dependent portion of each semicircular duct and of the utricle can easily be visualized in any head position. Moveable markers can mark the expected progress of otolith debris with changes in head position and images can be captured to document simulations. The model can be used to simulate pathology as well as diagnostic maneuvers and treatment procedures used for BPPV. The model has great potential as a teaching tool.
A simple model based on human anatomy has been created to allow careful study of BPPV pathophysiology and treatment. Going forward, this tool could offer insights that may lead to more accurate diagnosis and treatment of BPPV.
开发一种膜迷路的三维研究工具，以研究良性阵发性位置性眩晕（BPPV）的病理生理学、诊断检查及治疗。BPPV是周围性眩晕最常见的病因。其诊断和治疗依赖于对前庭迷路解剖结构及其相对于头部位置的了解。迄今为止，已有许多图示用于解释BPPV的诊断和治疗原则，但基于膜迷路解剖学研究的却很少。
对一具尸体的人膜迷路进行轴向切片，分辨率为20μm，染色并分割以创建高分辨率数字模型。克隆该模型以创建一对镜像迷宫。将这些模型与从MRI数据分割得到的人类头骨三维模型相关联，并根据既定的解剖学规范进行定向。创建代表耳石的管标记，以在三维环境中模型移动期间标记管石位置。
该模型可同时可视化双耳真实的膜迷路解剖结构。在任何头部位置都能轻松观察到每个半规管和椭圆囊的附属部分。可移动标记可随着头部位置的变化标记耳石碎片的预期移动过程，并且可以捕获图像以记录模拟情况。该模型可用于模拟BPPV的病理情况以及诊断操作和治疗程序。该模型作为教学工具具有很大潜力。
已创建一个基于人体解剖学的简单模型，用于仔细研究BPPV的病理生理学和治疗方法。展望未来，该工具可能会提供一些见解，从而实现对BPPV更准确的诊断和治疗。
