联合上颈段经颈静脉孔区入路的显微解剖学研究

目的 研究颈静脉孔区(JF)入路的显微解剖,利用该入路一期切除颅内外沟通型复杂病变.方法 成人尸头标本15例(30侧),在手术显微镜下进行联合上颈段经JF区入路的解剖操作,测量相关数据.结果 对C1～C4上颈段解剖,切除C1横突,游离椎动脉C1～C2段及水平段;充分切除颈静脉结节、颈静脉突及部分枕骨髁;迷路后切除乳突,显露半规管,轮廓化面神经垂直段,全程暴露乙状窦,打开颈静脉孔;扩大了JF区的显露并测得相关参数,如乳突尖间距枕髁外缘中点为(29.65±3.24)mm;枕髁后缘距舌下神经管内口为(10.10±0.81)mm;颈静脉球距面神经垂直段间距左为(6.8±0.35)mm,右为(4.6±0.33)mm.结论 此入路从多个方向对JF区充分暴露,使面神经、耳蜗、椎动脉、后组脑神经等结构得到保护,术中结合相关解剖参数可很好的完成一期全切JF区颅内外沟通型及延伸到上颈位的病变,提高治愈率、减少并发症、降低死亡率.

The micro-anatomical study of joint the high cervical with jugular foramen approach

Objective To investigate the micro-anatomical approach to resect both intracranial and extracranial jugular foramen tumors in one-stage. Methods With the aid of surgical microscope, fifteen cadaver heads were used to study the microsurgical anatomy of high cervical part and jugular foramen, measure relative data. Results Detailed dissection was performed on high cervical part between the 1st cervical vertebra and the 4th cervical vertebra, resect foramen processus transversi of the 1st cervical vertebra, free vertebral artery 2nd and 1st cervical vertebra segment and horizontal segment. The jugular tubercle, jugular tunisia and part of the occipital condylus was drilled away as much as possible, total exposure of lateral semicircular canal was completed after the removal of the mastoid revealed labyrinthinem. Then the sigmoid sinus and jugular bulb were skeletonized. The vertical of segment of facial nerve was fully skeletonized to study the necessity of the facial nerve translocation. Full exposure to the sigmoid sinus, open jugular foramen. JF areas expanded, and the measured parameters revealed. The distance was (29.65 ± 3.24)mm from mastoidalec to oncentrated focus of condyle (10.18 ± 0.81)mm from hinder margin of condyle to endostoma of hypoglossal canal. The left distance was (6.8 ± 0.35)mm from jugular foramen to perpendicular part of facial nerve, right was (4.6 ± 0.33)mm. Conclusions Total exposure of JF can be achieved through the approach we described, and will enable the facial nerve, cochlea, and the structure of the vertebral artery to be performed. Both intracranial and extracranial tumors can be removed in a one-stage procedure related to anatomical parameters. Improve the cure, reduce complication and lower mortality.