| Objective Use virtual reality technology to observe the involved bones,blood vessels,nerves and other related structures,walk shape and position relationships,explore the surgical approaches related to pontine hemorrhage,and implement surgical treatment of pontine hemorrhage.This design is more accurate,more intuitive,more comprehensive,and has descriptions and specific data.This is to provide theoretical guidance including increasing the safety and operability of the surgical treatment of pontine hemorrhage,removing the pontine hematoma to the greatest extent,and reducing surgery Related negative injury and displacement complications.Methods 1.Use CT thin-slice scan,enhanced nuclear magnetic field,MRA,MRV,etc.to scan 10 adult cadavers(20 sides in total),and use software to reconstruct the skull,blood vessels,and nerve fibers in three dimensions(3-D);2.Clarify the anatomical landmarks of the skull surface,middle cranial fossa,and posterior cranial fossa;3.Identify the relevant anatomical sites in the retrosigmoid approach,and measure the distance from the star point and the attachment site of the digastric muscle to the lower edge of the transverse sinus-sigmoid sinus junction;4.Observe the running routes and neighboring conditions of important nerves and blood vessels in the pontine cerebellar angle area,focusing on the origin and distribution of vessels V,VII,VIII,anterior inferior cerebellar artery,posterior inferior cerebellar artery,superior cerebellar artery,and pay attention to the relationship between them;5.Focus on measuring the distance from the brainstem end of the facial nerve to the mouth of the internal auditory canal,the distance between the brainstem end of the facial nerve and the brainstem end of the trigeminal nerve,the distance from the brainstem end of the trigeminal nerve to the petrous tip of the temporal bone,the distance from the brainstem end of the trigeminal nerve to the mouth of the internal auditory canal,and the distance from the brainstem end of the trigeminal nerve to the mouth of the jugular vein;6.To simulate the retrosigmoid approach,observe the marginal marking points A(At the same time passing outside of a bone window)to the petrous tip a of the temporal bone,b to the brainstem end of the trigeminal nerve,and c to the brainstem end of the facial and auditory nerve.From the distances of the target points in three different directions,three surgical routes R1,R2,and R3 were obtained respectively.To further explore how to better select a more precise surgical path based on the differences and tendencies of bleeding locations during the surgical treatment of pontine hemorrhage using the retrosigmoid approach.Results 1.The virtual three-dimensional reconstruction of the skull can well show the bone structure of the skull base;2.The retrosigmoid approach: circle 1 is the junction site of the posterior abdomen of the digastric muscle,circle 2 is the groove of the transverse sinus sigmoid sinus At the lower edge of the transition point,circle 3 is the star point.After measurement,the distance from circle 1 to circle3 is 35mm±1.75,circle 1 to circle 2 is 14.38mm±1.26,and the distance from circle 2 to circle 3 is 22.56mm±1.22.3.The SCA passes above the trigeminal nerve(V).The single-stem type has 13 sides with a ratio of 65%,and the double-stem type has 7 sides with a ratio of 35%;the brain stem end of the trigeminal nerve and the anterior inferior cerebellar artery(AICA),SCA,adjacent petrosal vein,nourishes by the vascular loop formed by the anterior inferior cerebellar artery and the lateral pontine artery;the facial nerve goes to the hilum of the inner ear,and the facial nerve and the auditory nerve are not fused.Near the hilum of the inner ear,the intermediate nerve runs between the vestibular cochlear nerve and the facial nerve between movement roots.4.The distance between end of the brainstem of the facial nerve and the internal auditory canal hole is 10.15 mm ± 1.64,the distance between end of the brainstem of the facial nerve and end of the brainstem of the trigeminal nerve is 4.25mm± 1.03,the distance between end of the brainstem of the trigeminal nerve and the petrosal tip of the tibia is 22.54 mm±1.65,the distance from end of the brainstem of the trigeminal nerve to the internal auditory canal hole6.45 mm±0.99,and the distance from end of the brainstem of the trigeminal nerve to the jugular vein hole is 10.72mm±1.82;5.The distance of path R1(A to a)is 35.67mm±1.33,the distance of R2(A to b)is 27.56mm±1.95 and the distance of R3(A to c)is25.60mm±2.01.After statistical blood analysis,R1 is greater than R2,R1 is greater than R3,and p is less than 0,05,which is meaningful;R2 and R3,p is greater than 0.05,meaningless.Conclusion 1.the operation of virtual 3D reconstruction technology is relatively simple,the same specimen can be reused,and multiple surgical approaches can be repeated on the same specimen.At the same time,it breaks the blind area of visual field observation of solid anatomy operation and can display the organization structure more intuitively.The shape and its relationship are due to the three-dimensional reconstruction of the specimen;2.It is very necessary to treat pontine hemorrhage lesions through retrosigmoid sinus approach and to master the anatomical structure in CPA and the shape of nerves and blood vessels is very necessary;3.When performing retrosigmoid sinus surgery,the first point for precise drilling should be as close as possible to the lower edge of the transverse sinus-sigmoid sinus transition to avoid damage to the transverse sinus and sigmoid sinus.At the same time,expand the surgical window as much as possible and apply virtual anatomical three-dimensional reconstruction technology to determine the drilling site first,and measure the distance from the drilling site to the star point and the digastric muscle site,which is helpful for the drilling site during the operation determine.4.Proficiency in the anatomical structure and nerves of the pontine cerebellar angle,the shape and adjacency of the blood vessels help to reduce the trigeminal nerve and the facial and auditory nerves during the removal of brainstem hematoma through the suboccipital-postsigmoid approach Complex,superior cerebellar artery,and anterior inferior cerebellar artery(AICA),etc.;5.The relative position of the trigeminal nerve and the facial-acoustic nerve complex can be determined through the internal auditory canal opening,jugular venous opening,petrosal anatomical sites,etc.It can avoid nerve damage;6.By comparing the three different approach directions of the retrosigmoid approach,it can provide a more advantageous approach direction when the focus of the pontine hemorrhage is different,and achieve the shortest path and least damage principle at the same time as possible.Provide some anatomical basis for individualized surgical treatment of pontine hemorrhage. |
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