Anatomical analyses of far lateral approach exposing anterior part of the foramen magnum in virtual reality system / 中华神经医学杂志

ABSTRACT

Objective:To analyze the anatomical relations between operating spaces of different paths via far lateral approach and exposure of the anterior part of the foramen magnum based on data of virtual reality three-dimensional model. Methods:The CT and MRI images of 50 patients with trigeminal neuralgia, admitted to our hospital from September 2015 to January 2019 were extracted from Gamma Knife databases and inputted into Vitrea virtual reality system to establish a three-dimensional anatomy model of the posterior cranial fossa. Posterior margin of the articular surface of occipital condyle was selected as starting point to open the skull via far lateral approach; the ipsilateral sublingual neural tube opening, anterior margin of the jugular tubercle, and anterior margin of the foramen magnum were selected as the exposed targets in the base of skull bony structure; the ligatures between starting point and the 3 exposed targets were used as axis to reveal a radius of 5 mm cylinder to simulate the surgical paths exposed the anterior margin of the foramen magnum via far lateral approach, and these surgical paths were named as Path 1, 2 and 3. The operating spaces of different paths were observed, and the frequency of each path passing through certain anatomical tissues was recorded and the volume of anatomical structures was measured. Results:There were significant differences in operating space volume, bony structure and volume of lower cranial nerves among the 3 paths ( P<0.05). The operating space volume of Path 3 was significantly increased as compared with that of Path 1 and 2, and bony structure and volume of lower cranial nerves of Path 2 were significantly increased as compared with those of Path 1 and 3 ( P<0.05). Conclusion:The data collected in the surgical paths via distal lateral approach simulated by virtual reality technology can help reveal the anatomical relationship in the operating space and provide a basis for selecting the best surgical path.