中颅底锁孔入路颞骨岩部重要结构的定位

目的研究中颅底锁孔入路颞骨岩部的重要结构关系,提供相应的解剖依据,以指导临床应用。方法模拟临床手术过程,在显微镜下对13具(26侧)成年国人灌注头颅标本进行解剖,观测颞骨岩部膝状神经节、颈内动脉、内耳道内侧缘、棘孔、蝶岩沟、弓状隆起和耳蜗之间的解剖关系。结果经棘孔后缘垂直于蝶岩沟的交点与膝状神经节连线位于Glasscock三角中棘孔和弓状隆起连线的内侧,构成新的三角位于Glasscock三角内侧,准确定位岩骨内颈内动脉,能避开鼓膜张肌和咽鼓管;岩浅大神经是磨除颞骨岩部十分重要的标志,通过它可以定位岩部颈内动脉、耳蜗和膝状神经节;根据弓状隆起的走行定位内听道长轴。结论经棘孔后缘垂直于蝶岩沟的交点、岩浅大神经和弓状隆起为标志定位岩骨内重要结构为手术提供了安全保证;中颅底锁孔入路具有创伤小、暴露好和并发症少等特点,特别适用于处理骑跨颅中、后窝的岩斜区病变。

Study on localization of the important pertrosal structurct of middle cranial fossa keyhole approach

Objective To study important anatomicl petrosal structural relationship through middle cranial fossa keyhole approach and provide correspondingly anatomical basis for more elaborate techniques of neurological surgery.Methods For anatomicl information,the microneurosurgical anatomical dissection,observation and measurement had been performed under microscope by mimicking clinical operation approach on 13 adult formalin-fixed cadaveric heads(26 sides).The anatomic relationship of the geniculate ganglion,the medial lip of the internal acoustic meatus,the ICA genu,arcuate eminence,foramen spinosum,petrosum shpenoid groove,cochlear was studied.Results The line between the geniculate ganglion and the intersection from perpendicular through the posterior border of foramen spinousm to petrosum sphenoid groove substituted the line between arcuate eminence and foramen spinosum of the Glasscock triangle,and constituted the new triangle which was located inside the Glasscock triangle.The new triangl could find out exactly petrosum arteria carotis interna and avoid the damage of the tensor tympani muscle and the eustachian tube.The greater superficial petrosal nerve was an important landmark in drilling petrous bone,and could find out the intrapetrous carotid artery(ICA),cochlear and geniculate ganglion(GG).The macroaxis of the internal acoustic meatus was located through the courser of arcuate eminence.Conclusion The localization of important anatomicl petrosal structurct through the greater superficial petrosal nerve,arcuate eminence and the intersection from perpendicular through the posterior border of foramen spinosum to petrosum sphenoid groove,could provide guarantee that drilling petrous bone is safe.The middle cranial fossa keyhole approach has good exposure and minimal complication and is especially suitable for the lesions that extend into the middle and posterior fossa.