侧颅底的CT影像与断层标本对照研究及临床意义

目的:为侧颅底病变的影像诊断和手术入路提供解剖学基础.方法:选取志愿者20名,在螺旋CT机上以眦耳线(CML)为基线对侧颅底结构进行层厚1mm连续扫描.选取成人尸体头颈部标本20例,以CML为基线制成层厚5 mm的连续断层标本.在经颈动脉管水平段和咽隐窝层面的CT影像及断层标本上,观察侧颅底结构的位置关系,测量侧颅底主要结构的径线及结构之间的距离.结果:侧颅底的CT影像及断层标本可清晰显示茎突、颈动脉管水平段等侧颅底结构及其毗邻关系,以及咽旁间隙内的结构,茎突是侧颅底影像诊断及手术入路中观察各结构之间位置关系和寻找血管、神经等的骨性标志.在CT影像及断层标本上,茎突至翼突的距离左、右侧分别为(45.98±2.71)mm和(46.14±2.57) mm、(45.96±2.72)mm和(46.12±2.52)mm,左、右侧差异无统计学意义(P＞0.05).结论:侧颅底的CT影像与断层标本的解剖对照研究,对侧颅底病变的影像诊断和指导手术入路等具有重要意义.

Anatomy Control Study of Lateral Cranial Base on the CT Imaging and Sectional Specimen and Its Clinical Significance

Objective：To provide anatomical basis for imaging diagnosis and surgical approach of lateral cranial base lesions. Methods：20 volunteers were selected and scanned in series with 1 mm in thickness by spiral CT from canthomeatal line（CML） of the lateral cranial base. Heads and necks of 20 adult corpses were selected and cut into serial sectional specimen with 5 mm in thickness from the CML. At the CT imaging and sectional specimen of lateral cranial base through the horizontal part of carotid canal and pharyngeal recess, relationship of the lateral cranial base structures was observed, the diameter and distance between the important structures of lateral cranial base was measured. Results：The CT imaging and sectional specimen could clearly display the styloid process, horizontal part of carotid canal of the lateral cranial base and its adjacent structures as well as the structures in parapharyngeal space of lateral cranial base. Styloid process was bony mark for observing relationship among the structures, searching the vessels and nerve with imaging diagnosis and surgical approach of the lateral cranial base. The distances from the styloid process to the left and right pterygoid process were （45.98± 2.71 ）mm and （46.14 ± 2.57 ） mm, （45.96 ± 2.72） mm and （46.12 ± 2.52 ） mm in CT imaging and sectional specimen respectively. Conclusions： CT imaging and anatomy control study is important for imaging diagnosis and surgical approach of the diseases of lateral cranial base.