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目的探讨CT仿真内镜(CT virtual endoscopy,CTVE)显示鞍底深部血管神经及其表面解剖标志在经蝶手术中的应用价值。方法 128例垂体瘤经蝶手术中,利用Navigator Guide软件对术前垂体CT检查数据进行蝶窦CTVE重建,了解CTVE对鞍底血管、神经及其解剖标志的显示情况。结果 CTVE能以三维图像的形式显示颈内动脉隆起、视神经管隆起、视神经管-颈内动脉隐窝,三者的显示率分别为:43.4%(111例)、37.5%(96例)、57.0%(146例)。通过传输函数设计技术(transfer functions),CTVE能透视显示出增强的颈内动脉100%(256例),可观察到有43.8%(112例)中隔附着于颈内动脉的浅面。通过动态调高观察阈值,CTVE能显示视神经管99.6%(255例),可观察到约17.3%(44例)中隔附着于视神经管表面。结论在经蝶手术中,术前CTVE能以三维图像的形式显示鞍底深部血管、神经及其解剖标志;术中能指导对上述鞍底血管、神经的辨认及鞍底骨窗形成。
Objective To investigate the value of CT virtual endoscopy (CTVE) in displaying the deep sella nerve and its anatomic landmarks in transsphenoidal surgery. Methods 128 cases of pituitary tumor during transsphenoidal surgery were treated with Navigator Guide software to perform sphenoid sinus CTVE reconstruction of preoperative pituitary CT data to understand the display of the vessels, nerves and their anatomical landmarks in the sellae. Results CTVE showed the internal carotid artery elevation, the optic canal uplift and the optic canal - internal carotid artery crypt in three-dimensional images, the rates of the three were 43.4% (111 cases), 37.5% (96 cases) and 57.0 % (146 cases). By transfer function transfer functions, CTVE revealed 100% (256 cases) of an enhanced internal carotid artery in perspective and 43.8% (112 cases) of the septum attached to the superficial part of the internal carotid artery. By dynamically increasing the observation threshold, CTVE showed 99.6% (255) of the optic canal and about 17.3% (44) of the optic canal attached to the optic canal surface. Conclusions In transsphenoidal surgery, preoperative CTVE can display the vessels, nerves and their anatomical landmarks in the deep sellae in the form of three-dimensional images. During the transsphenoidal surgery, they can guide the identification of the vessels and nerves in the sellae and the formation of the septal bone window.