颞下经岩尖-小脑幕入路手术的显微解剖研究

目的 为颞下经岩骨入路手术处理斜坡及脑干腹侧病灶提供解剖学资料。方法 模拟颞下经岩尖—小脑幕入路的手术操作,在手术显微镜下对20侧(10具)福尔马林固定的国人成年带颈头颅标本进行解剖,并观测各主要解剖结构的相互关系。结果 颞下硬脑膜外经前内侧的三叉神经压迹、外侧的岩浅大神经沟及岩上窦所形成的三角区磨削岩骨尖。其周围结构的测量结果为:上半规管垂直于岩骨嵴,位于弓状隆起下方,耳蜗位于内听道前方、岩骨颈内动脉膝后方,内听道位于上半规管与岩浅大神经夹角中央。20侧中有2侧面神经膝裸露,耳蜗至膝状神经节的距离约为3.30 mm±0.79 mm,耳蜗距颈内动脉膝约2.48 mm±1.14 mm,内听道距岩斜缝约16.03 mm±1.94 mm,颈内动脉水平段距岩上窦约10.73 mm±2.00 mm。结论 颞下经岩尖—小脑幕入路能增加岩斜坡及脑干腹侧的显露,但显露范围有限,且需一定程度的颞叶牵拉。同时可能因为不熟悉解剖而误伤耳蜗、颈内动脉及第Ⅶ脑神经、第Ⅷ脑神经,选择应用时应审慎考虑。

Microsurgical anatomy of the anterior subtemporal-medial transpetrosal approach to the petroclival region

Objective To obtain more detailed anatomic imformation about the anterior subtemporal transpetrosal approach to the upper brain stem and clivus. Methods Twenty sides of 10 adult cadaver heads fixed in formalin were used. The relationship of the main structures was observed and measured, and the actual surgical procedure was mimicked under the surgical microscope. Results The apical petrosal bone was removal via a subtemporal approach through the triangle area which surrounded by the superior petrosal sinus the greater superficial petrosal nerve and the edge of the mandibular nerve. The superior semicircular canal was located almost perpendicular to the petrosal edge under the arcuate eminence. The cochlea was located anterior to the internal auditory canal and posterior to the genu of petrosal carotid artery. The internal auditory canal was located in the line dividing the angle formed by the greater petrosal nerve and the superior semicircular canal. Two of the 20 sides facial genu had no bone cover. The average distance between the cochlea to the geniculate ganglion and the genu of petrous carotid was (3.03()0.79) mm and (2.48()1.14) mm, respectively. The average length of the internal auditory canal to petroclival suture was (16.03 () 1.94) mm, and the average height of the horizontal segment of petrous carotid to the superior petrosal sinus was (10.73()2.00) mm. Conclusion The anterior subtemporal-medial transpetrosal may improve the vison of the region of petroclival and ventral of the brain stem, but the exposure area is limited and There are also need a limited temporal lobe retraction and accidentally injury the cochlea, carotid artery and 6 to 8 nerves due to being unfamilliar with the anatomy. It must be considered carefully when using this appoach.