經鼻內視鏡手術（endonasal endoscopic approach, EEA）廣泛應用於鞍區與鞍旁區病灶，但手術暴露範圍與操作技巧的定量比較仍相當耗時，既有研究多仰賴屍體解剖或神經導航，本研究分析 50 部腦下垂體巨腺瘤手術影片，影片平均長度為 94.07 分鐘，範圍為 59 分鐘至 3.14 小時，影片分為參數設定資料集 10 部、驗證資料集一 20 部及驗證資料集二 20 部。
本研究建立使用者導引式人機協作電腦視覺（computer vision, CV）量測系統，以畫面中的 6、8、10 或 12 Fr Frazier 吸引管作為比例參考，使用者標註長度端點或目標區域多邊形後，系統依像素數量計算長度與面積，並以參數設定資料集建立水平與垂直方向的經驗性校正係數，固定套用於兩個驗證資料集，再以神經導航量測的兩側內頸動脈間距及蝶鞍高度驗證解剖距離量測結果。
電腦視覺與神經導航在兩側內頸動脈間距及蝶鞍高度的量測值均未觀察到顯著差異（p = 0.829 及 p = 0.671），依兩項解剖距離計算之相對量測準確度，在參數設定資料集、驗證資料集一及驗證資料集二分別為 95.1%、95.8% 及 96.2%，整體為 95.8%，電腦視覺與神經導航的平均長度量測時間分別為 75.8 秒與 76.1 秒，兩者未觀察到顯著差異（p = 0.913），平均面積量測時間則分別為 80.5 秒與 674.6 秒（p < 0.001），相較於神經導航，電腦視覺的面積量測時間縮短 88.1%。
殘餘腫瘤組的橫向暴露（p = 0.001）與校正後二維投影面積（p = 0.024）較小，縱向暴露在兩組間未觀察到顯著差異（p = 0.767），且術前腫瘤體積－暴露面積比值較高（p = 0.004），三種手術技巧間及早期組與經驗組間的橫向暴露、縱向暴露與校正後二維投影面積均未觀察到顯著差異，本系統可量化 EEA 手術影片中的解剖距離與校正後二維投影面積，並縮短面積量測時間，供術後影片回顧及手術技巧與術者經驗之探索性分析。

Quantitative assessment of surgical exposure during the endonasal endoscopic approach (EEA) is time-consuming and commonly relies on cadaveric studies or neuronavigation. We developed a user-guided computer-vision system that uses visible 6-, 8-, 10-, or 12-Fr Frazier suction tubes as scale references to measure anatomical length and corrected two-dimensional projected exposure area in operative videos. Fifty EEA procedures for pituitary macroadenoma were divided into a 10-case parameter-setting dataset and two 20-case validation datasets. Intercarotid distance and sellar height measured by neuronavigation served as anatomical reference values.
Computer-vision and neuronavigation measurements did not differ significantly for intercarotid distance (p = 0.829) or sellar height (p = 0.671), and relative measurement accuracy was 95.1%, 95.8%, and 96.2% across the three datasets. Length-measurement time was comparable (75.8 vs. 76.1 seconds, p = 0.913), whereas area-measurement time decreased by 88.1% (80.5 vs. 674.6 seconds, p < 0.001). Residual tumor was associated with smaller lateral exposure (p = 0.001), smaller corrected projected exposure area (p = 0.024), and a higher preoperative-tumor-volume-to-exposure-area ratio (p = 0.004), but not with longitudinal exposure (p = 0.767). Exposure did not differ among operative techniques or surgeon-experience groups. This system provides accurate, efficient measurements for postoperative video review and exploratory comparison of surgical exposure.

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