Abstract
The presentation of the surgical anatomy of anorectal malformation by standard anatomical figures is not suitable for individual anorectoplasty. It is essential to understand the anatomy of the pelvic muscle (striated muscle complex: SMC) including the external anal sphincter and their three-dimensional (3D) configuration in each patient. Thus, we studied the SMC three-dimensionally with multidetector-row helical computed tomography (MRH-CT) preoperatively, and evaluated its usefulness. Fourteen patients with anorectal malformations before anorectoplasty (types: high n=6, intermediate n=2, low n=6) and two patients without anorectal malformations as controls (total: male n=8, female n=8) were investigated. An image of pelvic region was prepared with a slice thickness of 0.5 mm and a reconstruction pitch of 0.5 mm. A 3D reconstruction on a conventional personal computer (PC) was made with a volume rendering method, and assisted by our own software. The SMC was analyzed with three modified modes of 3D reconstruction corresponding to the surrounding tissues. A length of the parasagittal muscle, and both the sagittal and transverse width of the vertical fibers in the SMC at the connection to the parasagittal muscle were measured on a 3D image and then compared among three different types and controls. To eliminate variations in age, a length index was used to allow comparison. The 3D configuration of the SMC was different in every case. The arranged image mode, which displayed the SMC and the pelvic bones simultaneously, enabled to use conventional knowledge in cysto-urethrography. The length of the parasagittal muscle was longest in the high type but the width of the vertical fibers was smallest. Anatomical figures of the SMC including the external anal sphincter were clearly demonstrated on a PC in every anorectal malformation by our program. A 3D reconstruction image provides positional information on the SMC for the body surface and pelvic bone at the same time. Both a 3D image and positional information with MRH-CT offers the surgeon a simulated operative profile of the SMC superior to CT or magnetic resonance imaging slices alone.
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