颞下入路术中颞骨岩部安全磨除范围分析

目的 探讨颞下入路术中岩斜区安全磨除范围。方法 选择25具（50侧）正常成人颅骨标本，观察并测量颞骨岩部重要解剖结构，包括岩浅大神经孔（A）、岩骨嵴（B）、三叉神经压迹外侧缘最高点（C）、颈内动脉岩骨水平段（D）、BC中点（G）、CD中点（H）、岩尖（I）、内听道顶部、AC中点（J）；然后，应用影像学资料加以验证，同时，应用成人尸头模拟颞下入路手术，在安全范围（矩形CGHJ）内磨除三叉神经压迹及其后外侧部分并观察显露的解剖结构。结果 HJ连线可作为内听道内侧缘在岩骨前壁的投影，此方法能有效定位内听道。在矩形CGHJ范围内磨除部分岩骨后，可观察到上斜坡、中斜破和内听道下方。结论 HJ连线可作为内听道内侧缘的岩骨前壁的投影；矩形GHJI可作为颞下硬膜外入路术中岩骨磨除的安全区域，而且有足够的暴露范围。

Safe abrasion range of petrous portion of the temporal bone during microsurgery via subtemporal approach for petroclival lesions

Objective To explore the safe removal range of petrous portion of the temporal bone during the microsurgery via subtemporal approach for the petroclival lesions. Methods Twenty-five normal adult skull specimens (50 sides) were used to observe and measure the important anatomical structures of the temporal bone, including the greater superficial petrosal foramen (A), the petrosal ridge (B), the highest point of the lateral edge of the trigeminal nerve indentation (C), the petrosal segment of internal carotid artery (D), midpoint of BC (G), midpoint of CD (H), petrosal apex (I), top of internal auditory canal, midpoint of AC (J). The imaging data were used to verify the measuring outcomes of the important anatomical structures. An adult cadaveric head was used to simulate the microsurgery via subtemporal approach, and the trigeminal nerve indentation and its posterolateral part were removed within a safe area (rectangular CGHJ) and the exposed anatomical structures were observed. Results The HJ line could be used as the projection of the medial border of the internal auditory canal on the anterior wall of the petrous bone, which could effectively locate the internal auditory canal. After removing the petrous bone in the rectangular CGHJ, the mid- and upper-part of slope, and the lower part of the internal auditory canal were fully exposed. Conclusions The HJ line can be used as the projection of the anterior petrous bone at the medial border of the internal auditory canal. The rectangular GHJI can be used as a safe area for petrous bone removal during the microsurgery via subtemporal approach for the petroclival lesions.