Abstract: Objective To discuss minimally invasive tactics for exposure of jugular foramen region in transpetrosal-presigmoidal approach based on virtual reality image model. Methods  CT and MRI scans were performed to 15 adult cadaver heads (30 sides), and image data was inputted into Vitrea virtual reality system to establish three-dimensional anatomical model of jugular foramen region. The transpetrosal-presigmoidal approach was simulated with selecting osseous landmark points to draw a cylinder. Minimally invasive simulation was performed by reducing the diameter of cylinder. Anatomic exposures in surgical trajectory following minimally invasive design were observed, measured and compared.  Results  Spacial sequence of nerves and vessels of jugular foramen region was exposured clearly with the route simulating transpetrosal-presigmoidal approach. Route before and after minimally invasive design passed through the interval between vertical segment of facial nerve and sigmoid sinus. There was a part of sigmoid sinus in the route. Cerebellar hemisphere was not included in the route. Data measurement and comparative analysis showed that volume of route, petrosal osseous structure and venous sinus involved in route before minimally invasive design was more than that after minimally invasive design. The differences reached statistical significance (P = 0.000). The volumes of lower cranial nerves between routes before and after minimally invasive design did not show significant differences (P = 0.552).  Conclusions  Minimally invasive route of transpetrosal-presigmoidal approach is helpful to reduce surgical injury of vital structures in effective exposure for target structures of jugular foramen region.

Key words: Petrous bone, Jugular veins, Microsurgery

摘要： 目的 虚拟现实系统模拟经岩骨乙状窦前入路显露颈静脉孔区的手术路径并探讨微创化策略。方法 15 具（30 侧）尸头标本行CT 和MRI 扫描，影像学数据输入虚拟现实系统以构建颈静脉孔区三维解剖模型，选择骨性标记点绘制圆柱模拟经岩骨乙状窦前入路手术路径，将圆柱直径缩小模拟手术路径微创化，观察并测量微创化前后手术路径中所包含的解剖结构。结果 虚拟现实系统模拟经岩骨乙状窦前入路显露颈静脉孔区的手术路径可清晰显示所包含的神经、血管等解剖结构的空间层叠顺序，微创化前后手术路径均由岩骨内面神经垂直段与乙状窦之间经过，包含部分乙状窦，不包含小脑半球。微创化后手术路径体积，以及路径中岩骨骨性结构和静脉窦体积均小于微创化前（P = 0.000）；微创化前后后组脑神经体积差异无统计学意义（P = 0.552）。结论 经岩骨乙状窦前入路手术路径微创化可在有效显露颈静脉孔区靶结构的情况下减少重要解剖结构的损伤。

关键词: 颞骨岩部, 颈静脉, 显微外科手术