颅骨CT三维重建在听神经瘤开颅手术中的应用

Application of three-dimensional cranial CT reconstruction in craniotomy of acoustic neuroma

关键词:  CT三维重建  横窦与乙状窦交界处  听神经瘤

Key words:  3D CT reconstruction  transverse-sigmoid sinus junction  acoustic neuroma

摘要:

目的　观察颅骨CT三维重建在枕下乙状窦后入路听神经瘤开颅术中的应用价值。方法　回顾性分析 12 例利用颅骨CT三维重建技术行乙状窦后入路听神经瘤开颅手术患者的临床、影像学资料。在CT三维重建图像的颅骨内 侧、外侧图上，先标记横窦乙状窦交界点，再测量标记点与二腹肌沟顶点及星点距离。术中将术前测量的两个距离作为半 径，分别以二腹肌沟顶点及星点作为圆点画圆，两圆的上面交叉点即为“关键孔”钻孔点。结果　每个病例都顺利暴露了 横窦乙状窦交接处边缘，术中未发生静脉窦受损。术后CT显示骨瓣复位良好。结论　颅骨CT三维重建技术有助于确定 横窦乙状窦交接处位置，操作简单快捷，避免静脉窦损伤，减少骨缺损。

Abstract:

Objective　To observe the application of three-dimensional cranial CT reconstruction in craniotomy of acoustic neuroma through suboccipital retrosigmoid approach. Methods　Clinical and imaging data of 12 patients with acoustic neuroma who underwent retrosigmoid approach craniotomy were retrospectively analyzed. On the medial and lateral views of 3D skull, the transverse-sigmoid sinus junction (TSSJ) was marked first, and then the distance between the marking point and the vertex and asterion of the digastric groove was measured. During the operation, two preoperatively measured distances were used as the radius, and the vertex and asterion of the digastric groove as the dots to draw a circle. The crossing point of the two circles was the“key-hole”. Results　The margin of TSSJ was successfully exposed in each case, and no venous sinus was damaged during operation. Postoperative CT showed good restoration of bone flaps. Conclusion　3D cranial CT reconstruction is simple and rapid for determining the position of TSSJ. Its use can avoid venous sinus injury and reduce bone defect.