骨性内耳道的解剖学观测

目的为内耳道手术定位提供解剖学依据。方法对400块颞骨的内耳道及其有关结构进行解剖观察和测量。结果内耳道与岩大神经管裂孔、弓状隆起等结构有较恒定的位置关系。内耳道底投影点至岩大神经管裂孔的距离,在左侧为8．85mm,在右侧为7．95mm;至弓状隆起最高点的距离在左侧为7．89mm,右侧为88．50mm,内耳道上壁长左侧为8．41mm,右侧为8．61mm。结论岩大神经管裂孔、弓状隆起等颞骨岩部结构是定位内耳道的重要标志。内耳道手术应避免损伤上半规管,耳蜗等结构。     

内耳道的解剖学研究及其临床意义

目的:HTSS为内耳道手术定位提供解剖学依据。方法:对400块颞骨的内耳道及其有关结构进行解剖观察和测量。结果:内耳道与岩大神经管裂孔、弓状隆起等结构有较恒定的位置关系。内耳道底投影点至岩大神经管裂孔的距离,在左右两侧分别为8.85mm、7.95mm;至弓状隆起最高点的距离在左侧为7.89mm,右侧为8.50mm,内耳道上壁长左侧为8.41mm,右侧为8.61mm。结论:岩大神经管裂孔、弓状隆起等颞骨岩部结构是定位内耳道的重要标志。内耳道手术应避免损伤上半规管、耳蜗等结构。     

以上半规管为标记内耳道手术的应用解剖

目的:为颅中窝进路内耳道手术提供解剖学依据。方法:采用福尔马林固定的头颅标本２４具(４８侧),首先寻找弓状隆起并磨出上半规管蓝线,进一步测量其与内耳道及相关结构的位置关系。结果:上半规管拱峰到内耳道后壁的投影距离为(６．１８±０．２５)ｍｍ(５．１１~７．２３ｍｍ),距前壁的投影距离为(１３．２３±０．４７)ｍｍ(１１．２~１４．２１ｍｍ)。上半规管拱峰与内听后壁的直线距离为(７．０３±０．２６)ｍｍ(６．０１~７．８５ｍｍ),距前壁为(１４．４４±０．７６)ｍｍ(１２．０３~１５．７７ｍｍ)。结论:本文测量数值,对临床上进行颅中窝进路的内耳道定位有较大的帮助。     

人工耳蜗植入经颅中窝入路的相关解剖

目的：为经颅中窝进行耳蜗植入术提供解剖资料，同时寻找定位植入点的方法。方法：取成人头颅标本15例（30侧），开颅后在颞骨岩部磨出蜗螺旋管底圈鼓阶最高点和相关结构，观测其与周围重要解剖结构的关系。结果：①颅中窝入路鼓阶植入点位于岩嵴下方，两者间骨质厚度为（8．58±2．28）mm；在内耳道前方，距内耳道底距离为（1．47±0．30）mm；在岩大神经后方，距其距离为（3．88±0．52）mm；在面神经内侧．距其距离为（2．80±0．26）mm；在前半规管内侧，距其距离为（9．46±1.01）mm；②植入点至蜗窗上缘豹鼓阶长度为（12．03±1．26）mm；③颈内动脉的膝部位于耳蜗的内下方，与蜗螺旋管底圈间骨质厚度为（1．54±0．47）mm；耳蜗最高点与颈内动脉膝部埋藏深度相差（6．67±2．07）mm。结论：①岩大神经是手术时重要的定位标志，面神经是手术中需要保护的重要解剖结构。     

面神经脑桥小脑角区和内耳道面神经相关解剖及临床应用

面神经是颅内第Ⅶ对脑神经,其毗邻解剖结构复杂。随着脑桥小脑角区手术死亡率的降低,面神经的解剖和保留情况直接关系到手术的效果和并发症,手术中解剖和保留面神经已经引起医生日益重视。现总结国内外在面神经脑桥小脑角区和内耳道解剖研究的进展,综述如下。1面神经的组织学特     

颅中窝进路内耳道手术的应用解剖学

为经颅中窝进入内耳道施行手术提供更简便的方法,在100侧成人颅骨标本上.对棘孔、岩大神经管裂孔、弓状隆起和内耳门等表面标志进行了观测,运用几何知识、找出形态规律;在20侧成人整颅标本上进行了摹拟手术;讨论了与临床应用有关的问题.     

内耳道底的断面解剖学研究

目的：进一步明确内耳道底各结构的断面形态，为影像诊断和手术治疗提供解剖学资料．方法：用火棉胶包埋技术将6例成人头颅标本制备成厚0．5～2mm的耳颞部横切片，观察内耳道底的结构。结果：选取2mm厚和0．5mm厚两种切片中典型的内耳道底上部层面和下部层面进行描述。结论：火棉胶切片很好地显示了内耳道底通过的结构及其毗邻关系，对该区的影像诊断和手术治疗有重要的参考价值。     

颅中凹进路内耳道定位研究

采用50侧成年头部标本,经颅中凹手术进路,以棘孔的胸膜中动脉、面神经管裂孔和上半规管拱峰为标志,对内耳道的位置进行确定。观测棘孔至面神经管裂孔的距离、面神经管裂孔至内耳道底面神经管内口的距离。膝状神经节裸露率,弓状隆起与上半规管拱峰的关系、上半规管拱峰至内耳道后壁的距离、内耳道上壁至岩上窦的距离,内耳道内上方骨突率,并提出不同手术应采取不同的标志对内耳道进行定位。     

面神经和位听神经在脑桥小脑角及内耳道的显微外科解剖

用手术显微镜观察了成年头颅标本33个(66侧)面神经的运动根、感觉根(中间神经)和位听神经。1.面神经和位听神经自脑干至内耳道底平均长20.52mm。2.面神经运动根丝1根55侧、2根8侧、3根3侧。运动根自发出点至与中间神经联合点平均长14.86mm。3.中间神经近侧段、中间段、远侧段平均长分别为4.95、9.36、6.45mm。中间神经中间段1根束30侧、2根束28侧、3根束6侧,4根束2侧。中间神经可分为A、B、C、D、E、F 6型。4.位听神经根据分出蜗神经和前庭神经顺序,可分为A、B、C、D 4型。本文联系中间神经切除术,讨论了中间神经的分型、经过、根数和交通支的临床应用意义。     

15例成年国人内耳膜迷路及内耳道MRI最大密度投影三维重建图像的解剖学研究

目的研究成年国人内耳膜迷路及内耳道最大密度投影(MIP)三维重建图像,观测内耳主要结构磁共振成像(MRI)的正常解剖测量值,为临床耳显微外科及神经外科手术提供解剖学依据。方法选用15名健康志愿者,使用GE-signal 1．5T超导型核磁共振机,环行耳颞部线圈,三维快速自旋回波序列(3D／FSE／T2W1)(水成像)及脂肪抑制技术,对两侧耳部同时进行扫描。原始扫描图像行MIP三维重建,多角度旋转对内耳主要结构进行解剖学观测。所得数据用SPSS10．0软件进行统计学分析。结果MIP三维重建能满意显示两侧内耳膜迷路及内耳道的解剖结构,其中3个膜半规管、椭圆囊、球囊、蜗管及内耳道呈高信号。测量结果内耳主要结构均无显著的侧别差异。结论临床MIP三维重建能直观、立体地显示内耳膜迷路及内耳道的结构,为成年国人内耳主要结构MRI正常解剖测量值的确立提供了一定的基础资料。     

A microanatomical map of the structures hidden in the middle fossa based on the facial nerve hiatus: Measurements and their variability

The aim of this study was to investigate the relationships/variations between the facial nerve hiatus (FNH) and middle cranial fossa neuro‐vascular structures. Twenty CT‐scanned middle cranial fossae of fresh adult cadavers were used; the greater superficial petrosal nerves, and critical neuro‐vascular structures were identified. Using the FNH as a reference point, a neuronavigation system was used to measure the distance between each structure and the FNH. The coefficient of variation (CV) was used to quantify the degree of variation among each distance. The mean distances and standard deviations between the various landmarks and the FNH, and the associated CV were analyzed. Furthermore, a microanatomical map of the structures hidden in the middle fossa based on the greater superficial petrosal nerve was generated. The most reliable relationships of the FNH were with the internal auditory canal (CV = 14.59), and with the vertical portion of the intrapetrous internal carotid artery (CV = 15.54). Our data demonstrate that the FNH can be used as anatomical landmark to plot the position of several hidden neurovascular structures when performing a middle‐fossa skull base approach. However, the pattern and the variation of these structures had to be recognized. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Topographic relationship between the cochlea and the middle fossa floor: the anatomical basis for an alternative approach to the cochlear turns

The cochlea has attained extreme surgical interest since cochlear implantation has been recognized as an established method for the management of certain types of bilateral profound hearing loss. Traditionally access to the cochlear turns is achieved through the middle ear. Extremely limited references exist in the literature regarding alternative surgical approaches to the cochlea. In the present study we tried to highlight the anatomic relationships of the superior aspect of the bony cochlea to the adjacent superficial structures of the petrous bone, as there have been suggestions that the cochlea is surgically accessible through the floor of the middle cranial fossa (MCF). A total of 58 dry human adult skulls (116 temporal bones) were studied. The groove for the greater superficial petrosal nerve (GGSPN) and the facial hiatus were used as landmarks in order to expose the superior aspect of the cochlea. Measurements were made of the following distances: a) between the MCF floor and the superficial part of the basal turn (SPBT), b) between the MCF floor and the apex of the cochlea, c) between the SPBT and the GGSPN and d) between the SPBT medially and the first genu of the facial canal laterally. Our results indicate that adequate and reliable surgical access to the bony cochlea could be achieved through the MCF floor.     

成人内听道底相关结构的多层螺旋CT解剖学观察

目的：应用64层MSCT观测成人内听道底及其相关的解剖结构,为临床应用提供影像解剖学依据。方法筛选2011年4—12月广东省人民医院采用64层MSCT扫描的乳突气化良好、无中耳或内耳病变且无眩晕等平衡功能障碍症状的40例共80耳成人CT资料进行回顾性分析。在MSCT图像上观测：横嵴,横嵴至前庭内侧骨壁的距离（ D1),面神经管迷路段、上前庭神经管、下前庭神经管和后壶腹神经管（单管)各管的长度、宽径,以及后壶腹神经管的内听道开口（单孔)至前庭内侧骨壁的距离（D2)。结果80耳的横嵴、面神经管迷路段、上前庭神经管、下前庭神经管和后壶腹神经管、单孔在横断位、冠状位及矢状位均能显示。其中横嵴局部解剖位置清晰、稳定,位于内听道底的中部,内侧缘自前内向后外走行,D1为（1．56±0．55)mm（0．55~2．67 mm)。面神经管迷路段长度（2．60±0．34)mm（1．54~3．27 mm),宽径（0．91±0．23)mm（0．50~1．58 mm);上前庭神经管长度（3．39±0．52) mm（2．50~5．06 mm),宽径（1．03±0．19)mm（0．74~1．62 mm);下前庭神经管长度（1．35±0．27) mm（0．74~2．17 mm),宽径（1．34±0．25)mm（0．85~2．34 mm);后壶腹神经管长度（3．88±0．84) mm （2．58~6．00 mm),宽径（0．63± 0．12) mm （0．42~0．98 mm)。 D2为（2．50±0．72)mm（1．37~5．01 mm)。结论64层螺旋CT能较好地显示位于内听道底的横嵴以及面神经管迷路段、前庭上神经、前庭下神经、后壶腹神经各骨管和单孔的走行及形态特征,为内耳疾病的诊断、鉴别诊断及术前评估提供有参考价值的信息。     

Comparison of microscopic and endoscopic view of the internal acoustic meatus: A cadaveric study

The endoscope is thought to provide an improved exposure of the internal acoustic meatus after retrosigmoid craniotomy for microsurgical resection of intrameatal tumors. The aim of this study is to quantify the differences in internal acoustic meatus (IAM) exposure comparing microscopic and endoscopic visualization. A retrosigmoid approach was performed on 5 cadaver heads. A millimeter gauge was introduced into the internal acoustic meatus, and examinations with a surgical microscope and 0°, 30° and 70° rigid endoscopes were performed. The extent of IAM depth visualized with the microscope and the different angled endoscopes were analyzed. The microscopic view allowed an average IAM depth visualization of 2.8 mm. The endoscope allowed an improved exposure of IAM in all cases. The 0°, 30° and 70° endoscopes permitted an exposure that was respectively 96% (5.5 mm), 139% (6.7 mm) and 200% (8.4 mm) more lateral than the microscopic view. Angled optics, however, provided an image distortion, specifically the 70° endoscope. The endoscope provides a superior visualization of the IAM compared to the microscope when using a retrosigmoid approach. The 30° endoscope represented an ideal compromise of superior visualization with marginal image distortion. Additional implementation of the endoscope into microsurgery of intrameatal tumors likely facilitates complete tumor removal and might spare facial and vestibulocochlear function. Clin. Anat. 31:398–403, 2018. © 2017 Wiley Periodicals, Inc.     

枕下乙状窦后入路内听道后壁磨除的显微解剖

目的 观测经枕下乙状窦后入路手术路径中,显微镜下磨除内听道后壁所涉及的重要解剖结构及相关解剖学参数,以指导术中安全磨除内听道后壁。方法 模拟枕下乙状窦后入路,对6具(12侧)国人湿性头颅标本显微镜下行磨除内听道后壁,以内听道内口后缘中点(P点)作为参照点,分别测量P点至弓状隐窝、后半规管、共脚、内听道底、前庭导水管外口、颈静脉孔的最短距离,对这些结构拍照记录,所得测量结果行统计学处理。结果 以内听道后壁作为参照平面,测得内听道干与后壁平面所呈夹角为47.3°±17.2°。以P点作为参照点,测得P点至弓状隐窝的最短距离(4.10±0.60)mm,P点至后半规管最短距离(7.39±0.44)mm,P点至共脚的最短距离(8.09±0.47)mm,P点至内听道底距离(9.08±0.59)mm,P点至前庭导水管外口(10.44±0.73)mm,P点至颈静脉孔最短距离(7.35±1.09)mm。结论 枕下乙状窦后入路磨除内听道后壁,其磨除长度不应超过7 mm,可减少半规管及共脚的损伤概率。熟悉磨除内听道后壁过程中容易损伤的结构,可避免损伤半规管、颈静脉球、前庭导水管外口及内淋巴囊等重要解剖结构。     

侧颅底神经血管的应用解剖学——颞下窝径路的外科解剖学研究

目的：通过对侧颅底区神经血管的临床应用解剖学观察,为术中保全脑神经和重要血管提供解剖学基础。方法：对２１侧成人尸头按ＦｉｓｃｈＡ、Ｂ型颞下窝手术进路进行解剖,观察颈静脉球区域神经血管解剖关系;观察颈内动脉及毗邻的解剖关系。结果：颈静脉球可分为隆起型（占６６．７％）和低平型（占３３．３％）。岩下窦开口部位有三种类型。Ⅸ脑神经多位于颈静脉球的前内侧,Ⅹ、Ⅺ脑神经多位于其内侧。Ⅺ脑神经与岩下窦末端关系密切,可分三种类型。颈内动脉水平段距鼓膜张肌平均为２．２ｍｍ,距脑膜中动脉和下颌神经分别平均为６．８ｍｍ和６．９ｍｍ。结论：避免手术损伤后脑神经的关键是充分暴露,辨认清楚后明视下操作。鼓膜张肌、脑膜中动脉、下颌神经是预测和辨认颈内动脉水平的良好标志。     

颧面部缩小术中耳颞部辅助切口设计的应用解剖学

目的:研究颞浅动脉额支、面神经额支的行程和颞下颌关节的位置,探讨三者的解剖学关系,为颧面部缩小手术中设计耳颞部辅助切口提供解剖学依据。方法:对14例防腐成人尸体(28侧)和2例新鲜成人尸体(4侧)头部标本进行解剖,建立坐标系观察并测量颞浅动脉额支、面神经颞支的走向和颞下颌关节位置,并分析三者关系。结果:①在耳屏点X轴和眉外端B作X轴平行线之间,颞浅动脉额支总走行在面神经额支后上方,面神经额支走向角度与颞浅动脉额支基本一致。在耳屏点与眉外端上方30m m处(TE)连线的区域以下为面神经额支分布区域,在该连线的垂直方向上可获得面神经额支最上支与颞浅动脉之间最远距离为(22.32±9.16)m m,分布范围在耳上基点前(32.68±7.53)m m;②颞下颌关节盘前缘距关节结节止点距离为(3.40±0.75)m m,在耳屏点前(18.60±3.60)m m。结论:在TE连线后上方,无血管搏动的发际内作平行TE连线的切口,可有效避免神经血管损伤;在关节结节止点前至少5 m m的距离外(约耳屏前25 m m处)截骨,避免进入颞下颌关节腔内损伤关节盘。