Minimally invasive research of presigmoidal approach for exposure of jugular foramen region utilizing virtual reality system

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.

DOI: 10.3969/j.issn.1672-6731.2015.04.011