腭鞘管、翼管与岩骨段颈内动脉的内镜手术应用解剖与进展

近年来,国外内镜下围绕着翼腭窝及颈内动脉区病变的内镜手术逐渐开展,对翼腭窝及其通道腭鞘管、翼管区的解剖研究亦不断深入。国内相关学者内镜下经鼻入路岩尖、颈内动脉区、斜坡及颅颈交界区解剖和临床应用解剖研究极少报道,究其原因,主要还是因为该区域重要解剖结构复杂而多变异,缺乏可以信赖的恒定的解剖标记,导致内镜颅底手术进展缓慢。内镜手术中,定向、定位障碍是耳鼻喉科医生和神经外科医生面临的最大风险^[1]。     

复发性鼻咽癌内镜挽救手术中颈内动脉出血的处理

目的 探讨复发性鼻咽癌鼻内镜挽救手术中的颈内动脉破裂出血的原因、应急处理措施。方法 回顾性分析青岛大学附属医院耳鼻咽喉头颈外科自2020年3月—2021年2月收治的2例复发性鼻咽癌患者术中发生颈内动脉破裂的临床资料,2例患者均采用电磁导航辅助鼻内镜入路行鼻咽恶性肿瘤切除术,发生颈内动脉破裂出血后,均以长碘仿纱条暂时压迫止血,紧急行颈内动脉血管内栓塞术,术后予以抗感染、抗凝及对症支持治疗。结果 治疗后2例患者围术期生命体征稳定,未出现近期及远期相关并发症。结论 比邻、侵犯或包绕颈内动脉的中晚期复发性鼻咽癌患者术前应充分评估颈内动脉状态及代偿情况,术中一旦出现颈内动脉破裂出血,应立即行碘仿纱条填塞压迫止血并紧急行介入治疗,可挽救患者生命、减少脑梗死等并发症的发生。     

Endoscopic endonasal approach to the craniovertebral junction

The surgical approach to lesions of the ventral craniovertebral junction (CVJ) has evolved significantly in the last several years with the advent of endoscopic...     

Infratemporal fossa approach to the hypoglossal canal: practical landmarks for elusive anatomy

OBJECTIVE: At the conclusion of the article the readers should be able to safely and reliably find the hypoglossal canal using the infratemporal fossa approach. HYPOTHESIS: Very little has been written on the regional anatomy of the hypoglossal canal as seen through a transtemporal approach. This project attempts to further define the anatomy of the hypoglossal canal and provide the surgeon with guidelines for reaching it. Our hypothesis is that the hypoglossal canal can be safely and consistently reached by way of the temporal bone with preservation of hearing and cranial nerves (CN) IX to XI. STUDY DESIGN: Prospective anatomic study. METHODS: The study was performed using cadaver temporal bones. Infratemporal fossa Fisch type-A dissections were performed. The hypoglossal canal was then completely exposed. The distance from the canal to the jugular bulb, carotid artery, round window, lateral canal, and roots of CN IX to XI were recorded. RESULTS: Fifteen temporal bones were dissected and measured. The position of the hypoglossal canal is consistently located anterior, inferior, and medial to the jugular bulb. The distance from midcanal to the jugular bulb and the roots of CN IX to XI at the posterior fossa dura was 5.3 mm +/- 0.82 and 7.1 mm +/- 2.49, respectively. The distance from the carotid artery where it meets the jugular vein to the midcanal was 15.3 mm +/- 2.09. The distance from the round window to the canal was 21.7 mm +/- 3.17. CONCLUSIONS: The hypoglossal canal can be consistently reached using the infratemporal fossa approach. Hearing and CN IX to XI can be preserved. The distance from the jugular bulb and roots of CN IX to XI can be used as guideposts. If a tumor is involving the bulb, then the carotid artery and the round window are the next most reliable indicators of position.     

颈内动脉颅底段重要解剖标志点的影像学测量

目的了解正常成人颈内动脉岩内段各点与咽鼓管圆枕的距离,为鼻内镜颅底相关手术的安全操作提供重要的参考依据。方法选择50例正常成人颅底为研究对象,采用薄层高分辨率CT扫描和图像放大,三维重建,对颈内动脉岩内段距咽鼓管圆枕的距离进行测量,并对测量值进行统计学处理。结果咽鼓管圆枕距离同侧破裂孔距离为（17.440±0.213）mm,距离同侧颈内动脉管外口（27.322±0.271）mm,距离右侧卵圆孔（22.000±0.323）mm。男性咽鼓管圆枕与左侧卵圆孔距离为（21.122±0.314）mm,女性咽鼓管圆枕与左侧卵圆孔距离为（21.228±0.617）mm。结论该研究为鼻内镜颅底手术的安全操作提供了重要的参考依据,对术中暴露和保护岩骨段颈内动脉极为重要,能有效避免术中损伤颈内动脉造成致死性大出血。