Despite advancement of surgical techniques, the attachments of petroclival meningiomas near the central clival depression (CCD) remain difficult to visualize. With existing methods, the amount of tumor near the CCD that is inaccessible through various approaches cannot be compared. Tumors distort the brainstem, changing the size of the operative corridor for some but not all approaches; therefore, using cadavers with normal posterior fossae makes it impossible to compare different approaches to the tumor. The authors used virtual reality (VR) models created from the imaging data of patients to compare various surgical approaches that have otherwise been incomparable in previous studies.

CT and MRI data obtained in 15 patients with petroclival meningiomas were used to create anatomically accurate 3D VR models. For each model, various surgical approaches were performed, and the surgical freedom to 6 targets of the regions were measured. Furthermore, portions of the tumor that were visually blocked by the brainstem or bony structures were segmented and recorded as blinded volumes for comparison.

The extended retrosigmoid approach generated excellent exposure of the petroclival region, but for most specimens, there was inaccessible tumor volume adjacent to the brainstem (mean 641.3 mm3, SE 161.8). In contrast, the brainstem sides of the tumors were well-visualized by all the transpetrosal approaches. The blinded volume of the tumor was largest for the retrolabyrinthine approach, and this was statistically significant compared with all other approaches (mean 2381.3 mm3, SE 185.4).

The authors performed a novel laboratory study by using patient CT and MRI data to generate 3D virtual models to compare surgical approaches. Since it is impossible to perform various approaches in separate surgeries in patients for comparison, VR represents a viable alternative for such comparative investigations.

尽管手术技术有所进步，但中央斜坡凹陷 (CCD) 附近的岩斜区脑膜瘤的附件仍然难以观察。使用现有方法，无法比较通过各种方法无法接近的 CCD 附近的肿瘤数量。肿瘤会扭曲脑干，改变部分入路手术通道的大小，但并非所有入路；因此，使用具有正常后颅窝的尸体无法比较不同的肿瘤治疗方法。作者使用根据患者影像数据创建的虚拟现实 (VR) 模型来比较各种手术方法，这些方法在以前的研究中是无法比拟的。

在 15 名岩斜脑膜瘤患者中获得的 CT 和 MRI 数据用于创建解剖学上准确的 3D VR 模型。对于每个模型，进行了各种手术方法，并测量了该区域 6 个目标的手术自由度。此外，被脑干或骨结构视觉阻挡的肿瘤部分被分割并记录为盲体积以供比较。

扩展乙状结肠后入路可以很好地暴露岩斜区，但对于大多数标本，脑干附近存在难以接近的肿瘤体积（平均 641.3 mm3，SE 161.8）。相比之下，肿瘤的脑干侧在所有经岩骨入路中都清晰可见。迷路后入路的肿瘤盲体积最大，与所有其他入路相比具有统计学意义（平均 2381.3 mm3，SE 185.4）。

作者通过使用患者 CT 和 MRI 数据生成 3D 虚拟模型来比较手术方法，进行了一项新的实验室研究。由于不可能在患者的不同手术中执行各种方法进行比较，因此 VR 代表了此类比较研究的可行替代方案。