Quantitative research of microsurgical anatomy of transfrontal approach for cavernous sinus by virtual reality skill

Abstract

Objective To evaluate the microsurgical characteristics of different exposure for cavernous sinus through transfrontal approach by Dextroscope virtual reality system quantitatively. Methods Three ⁃ dimensional anatomic models of cavernous sinus were constructed in the Dextroscope virtual reality system according to CT and MRI of five adult cadaver heads. Triangular facets were made by lining landmark points selected on the calvaria and skull base to simulate craniotomy window and regions exposed for cavernous sinus (triangular facet A, B, and C), respectively. Results As comparison showed for areas of different triangular facets of exposed region, facet B was largest with significant difference (P = 0.000, for all). Comparison did not show significant difference among facet A, B, and C for volume of operative space and brain tissue involved (P > 0.05). Volume of anterior clinoid process drilled before cavernous sinus was larger for facet C than facet B and A (P = 0.000, for all). Volume of exposed internal carotid artery and its branches before surgical entry to cavernous sinus was larger for facet B than facet C and A (P = 0.000, for all). Volume of anterior clinoid process drilled after entering cavernous sinus was larger for facet B than facet C (P = 0.000). Volume of cranial nerves and internal carotid artery in the exposed region of cavernous sinus : facet B > facet C > facet A (P = 0.000, for all). There was no significant difference between facet A and facet B as to the volume of pituitary in the exposed region of cavernous sinus (P > 0.05), and pituitary was not exposed through facet C. Conclusion Convenience, vivid manifestation, quantitative measurement, and repeated utilization are prominent advantages of virtual reality technique to simulate transfrontal approach for exposure of cavernous sinus. DOI：10.3969/j.issn.1672-6731.2011.06.002