摘要： 目的 利用Dextroscope 虚拟现实系统定量评价经额入路显露海绵窦区的显微解剖特点。方法 根据尸头CT 和MRI 影像数据，以Dextroscope 虚拟现实系统构建海绵窦三维解剖模型，分别选择颅盖和颅底标识点连成三角形模拟手术骨窗和海绵窦不同显露术野（三角面A、B、C）。结果 不同术野三角形面积比较，B 面术野最大（均P = 0.000），但是到达术野前的操作空间和经过脑组织的体积A、B、C三面之间差异无统计学意义（P > 0.05）。经C 面术野到达海绵窦前所需磨除前床突和显露颈内动脉及其分支的体积，分别大于经B 面和经A 面术野（均P = 0.000）；经B 面术野进入海绵窦后磨除前床突的体积，以及显露脑神经和颈内动脉的体积分别大于经C 面和A 面术野（均P = 0.000）；经A 面术野与经B 面术野进入海绵窦后显露垂体的体积差异无统计学意义（P > 0.05）；经C 面术野不显露垂体。结论 虚拟现实技术模拟经额显露海绵窦显微手术入路具有快捷、直观、量化、可重复等优势。

关键词: 海绵窦, 脑肿瘤, 计算机, 模似, 显微外科手术

Abstract: Objective To evaluate the microsurgical characteristics of different exposure for cavernous sinus through transfrontal approach by Dextroscope virtual reality system quantitatively. Methods Three-dimensional anatomic models of cavernous sinus were constructed in the Dextroscope virtual reality system according to CT and MRI of five adult cadaver heads. Triangular facets were made by lining landmark points selected on the calvaria and skull base to simulate craniotomy window and regions exposed for cavernous sinus (triangular facet A, B, and C), respectively. Results As comparison showed for areas of different triangular facets of exposed region, facet B was largest with significant difference (P = 0.000, for all). Comparison did not show significant difference among facet A, B, and C for volume of operative space and brain tissue involved (P > 0.05). Volume of anterior clinoid process drilled before cavernous sinus was larger for facet C than facet B and A (P = 0.000, for all). Volume of exposed internal carotid artery and its branches before surgical entry to cavernous sinus was larger for facet B than facet C and A (P = 0.000, for all). Volume of anterior clinoid process drilled after entering cavernous sinus was larger for facet B than facet C (P = 0.000). Volume of cranial nerves and internal carotid artery in the exposed region of cavernous sinus : facet B > facet C > facet A (P = 0.000, for all). There was no significant difference between facet A and facet B as to the volume of pituitary in the exposed region of cavernous sinus (P > 0.05), and pituitary was not exposed through facet C. Conclusion Convenience, vivid manifestation, quantitative measurement, and repeated utilization are prominent advantages of virtual reality technique to simulate transfrontal approach for exposure of cavernous sinus.

Key words: Cavernous sinus, Brain neoplasms, Computers, analog, Microsurgery