面神经迷路段的手术入路和显微解剖关系研究

目的探讨以面神经迷路段手术入路为依据的面神经迷路段和毗邻结构的显微解剖以及各手术入路的比较解剖.方法对6例(12侧)福尔马林固定的成人头颅标本依顺序模拟经乳突-上鼓室入路、经迷路入路、经颅中窝入路的手术操作,对各入路涉及的解剖学标志及暴露范围进行观测.结果经乳突-上鼓室入路可以显示面神经的乳突段、鼓室段、迷路段远侧端的0.94 mm±0.06 mm和膝状神经节;经迷路入路可以显示颞骨内段面神经全程;经颅中窝入路对于迷路段近脑端的面神经管入口、远侧端的膝状神经节及其分支岩大神经节均显露良好.各手术入路均可确定恒定的解剖标志对面神经加以保护.结论各手术入路对迷路段面神经暴露程度不同,存在不同的优缺点,临床应用须根据实际情况进行选择.     

面神经

20030966面神经迷路段的手术人路和显微解剖关系研究/梅凌云…//中国耳鼻咽喉颅底外科杂志一2003,8(4)一230一233 目的:探讨以面神经迷路段一手术入路为依据的面神经迷路段和毗邻结构的显微解剖以及各手术入路的比较解剖。方法:对6例(12侧)福尔马林固定的成人头颅标本依顺序模拟经乳突一上鼓室入路、经迷路入路、经颅中窝入路的手术操作,对各入路涉及的解剖学标志及暴露范围进行观测。结果:经乳突一上鼓室入路可以显示面神经的乳突段、鼓室段、迷路段远侧端的0.94mm士0.o6mm和膝状神经节;经迷路入路可以显示颖骨内段面神经全程;经颅中窝入路…     

与后岩骨入路相关的多排螺旋CT影像解剖学研究

目的探讨针对活体行CT多平面重建图像的定量测量在后岩骨手术入路中的应用价值。分析与手术相关的乳突气化、乙状窦前置、颈静脉球高位间是否存在相关性。方法收集螺旋CT颅底三维重建而无颅底疾病的成年人数据资料119例（238侧）,在ADW4.2重建工作站上利用多平面重建技术重建出轴位和冠状位的图像,定量测量解剖结构间的距离。将测量结果与已有的在尸头标本上测量的数据进行统计学比较。统计乳突气化分型、乙状窦前置及各型颈静脉球高位的发生率,并对其作统计学分析。结果 CT多平面重建定量测量结果与对应的解剖测量结果无显著性差异;气化型乳突和非气化型乳突组间乙状窦前置发生率有极显著性差异;乙状窦前置和正常乙状窦组间颈静脉球高位的发生率有极显著性差异;气化型乳突和非气化型乳突组间颈静脉球高位发生率有显著性差异;乙状窦沟前缘至外耳道后壁的距离与外半规管至颈静脉球窝顶的垂直距离、面神经垂直段至颈静脉球窝最短距离、乙状窦沟底至乳突外表面的距离呈正相关。结论 CT多平面重建图像的定量测量结果可以代表实际的相关解剖结构间的距离,可为手术入路的选择及术中准确定位有关结构提供有价值的依据。非气化型乳突更易出现乙状窦前置和颈静脉球高位,说明乙状窦前置和颈静脉球高位的发生与颞骨气化有关;乙状窦前置时,乙状窦更易发生外移,颈静脉球更易发生高位,面神经垂直段至颈静脉球距离更短。     

乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫

目的:探讨乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫的临床疗效。方法:对2006-01-2008-04收治的26例外伤性面瘫患者行乳突-颞下迷路外径入路面神经减压术。面神经功能House-Braek-mann分级:Ⅴ级12例,Ⅵ级10例,Ⅲ级4例。术前纯音测听检查示:16例纵行骨折语频气导平均听阈为52dB,10例混合性骨折均为重度感音神经性聋。颞骨轴位CT示:13例可见骨折线。虚拟耳镜观察9例听骨链中断,面神经曲面重建显示膝状神经节区、鼓室段及乳突段骨管不规整。结果:全部患者术后一期愈合,无手术并发症发生。术后随访0.5～3.0年,平均1.2年。面神功能恢复达House-BrackmannⅠ级15例,Ⅱ级6例,Ⅲ级5例;语频气导听力平均提高33dB。结论:乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫高位面神经减压保全和重建听骨链效果满意。     

鼓室成形术中面神经定位和保护

目的为避免医源性面神经麻痹,探讨鼓室成形术中所涉及的面神经水平段和垂直段的定位和保护措施。方法从2004年4月～2006年12月共185例行鼓室成形术。以鼓索神经、砧骨窝、水平半规管、面神经鼓索三角及水平段面神经血管纹作为定位和保护标志。结果全部病例中,术前存在面神经麻痹1例,术后即刻面神经麻痹1例,术后迟发面神经麻痹1例,发现面神经裸露25例。通过经验和教训,指出鼓室成形术中面神经定位的重要性和保护处理的原则。结论中耳乳突的固定标志是面神经的参照物,可作为术中及早且直接定位面神经的手术标志,保证了手术的安全性。     

基于CT的前庭蜗器断层解剖研究

目的从形态学角度阐述前庭蜗器断层解剖的微细结构,为人工耳蜗植入术和相关工作提供参考.方法采用火棉胶切片制作法,分水平位和冠状位切片并与CT断层扫描方位一致,选择代表性层面进行观察描述.水平位自下而上分蜗窗龛、蜗窗、锤骨柄、锤骨颈、锥隆起、面神经鼓室段、面神经膝、外半规管等8个层面描述;冠状位自前向后分耳蜗、前庭窗、蜗窗、面神经乳突段等4个层面描述.结果观察前庭蜗器各断层解剖的微细结构,并将火棉胶切片与CT扫描图像相对照,显示面神经迷路段终段、面神经膝和面神经鼓室段起始部与耳蜗中间周、基底周关系密切,将水平位切片与冠状位切片相结合,可全面显示面神经与耳蜗的位置关系,经比较水平位切片更具优势.冠状位切片可清晰的显示出蜗窗龛和蜗窗的解剖结构.结论通过分析研究面神经与耳蜗的位置关系以及蜗窗龛和蜗窗的解剖结构,对避免人工耳蜗植入术中对面神经的损伤和耳蜗钻孔位置定位及电极插入等都具有极大的帮助.     

成人面神经管螺旋CT曲面重建图像的解剖学研究

目的探讨螺旋CT曲面重建图像对面神经管解剖学研究的参考价值.方法对50例正常成人(100侧)面神经管进行螺旋CT曲面重建,描述正常成人面神经管曲面重建图像的解剖特征,并进行测量.结果 50例正常人的轴位和冠状位曲面重建图像,可在一幅图像上清晰显示双侧面神经管结构,显示率100%,矢状位曲面重建图像只能完整显示单侧面神经管结构;三个方位曲面重建图像上能较准确测得面神经管长径和宽径,测量值差异无显著性意义(P>0.05),而对弯曲部的显示、测量和对毗邻结构的显示,不同方位有各自价值和限度.结论螺旋CT面神经管曲面重建图像具有简便、实用、准确、直观等优点,是目前研究面神经管影像解剖的良好方法.对面瘫定位诊断具有重要指导意义.     

HRCT指导下人工耳蜗植入术相关的解剖研究

目的:在HRCT扫描重建的引导下,模拟人工耳蜗植入入路主要步骤解剖,作相关的解剖和HRCT数据测量对照以便为人工耳蜗植入术前影像学评估提供指导.方法:通过6例儿童颞骨标本解剖,模拟人工耳蜗主要步骤解剖,解剖前后作HRCT横轴位和斜矢状位扫描,观察测量手术解剖和HRCT之间的关系.结果:解剖测量面神经隐窝宽度在蜗窗水平为(3.13±0.34)mm,在前庭窗水平宽度为(4.12±0.44)mm,HRCT测量面神经隐窝宽度在蜗窗水平为(3.20±0.38)mm,在前庭窗水平为(4.14±0.47)mm,斜矢状位HRCT可使面神经垂直段、水平段全程显示.解剖测量数据与HRCT测量数据差异无统计学上意义(P>0.05).结论:横轴位面神经到外耳道后壁的距离、斜矢状位面神经到蜗窗距离是反映面神经位置关系的很重要的参数,面神经垂直段 、外耳道后壁、蜗窗是测量的重要解剖标志,术前作HRCT人工耳蜗植入相关测量可用来指导临床手术.     

中耳乳突手术中面神经隐窝的处理策略

面神经隐窝在中耳乳突的显微外科手术中占有重要地位,其复杂的解剖结构和处理方式是中耳乳突显微手术中难于掌握和术后易于复发的主要原因之一。本文介绍了该区域的相关外科处理对策,包括经此清除病灶的乳突手术、听力重建手术及经此入路的人工耳蜗手术、面神经减压手术等不同的处理策略。     

面神经及其他

293 前上鼓室胆脂瘤所致面瘫[英]/Chu FWK…∥Laryngoscope·-1988,98(3)·-274～279 作者报道前上鼓室胆脂癌致面瘫5例,同时复习该部位的解剖,探讨面瘫的发病机理。上鼓室胆脂瘤可经不同的解剖部位损伤面神经。最常见的部位为面神经中耳段。作者报道的上鼓室胆脂瘤侵犯面神经的途径不是常见的后上鼓室,而是前上鼓室。该部位的解剖结构复杂。认为以下因素可能促使前上鼓室胆脂瘤的形成,如乳突切除术后后上鼓室与乳突腔融合,残留或复发的胆脂瘤可侵及槌、砧骨的上     

经耳内镜鼓窦与上鼓室入路人工耳蜗植入的解剖研究

目的 探讨经耳内镜鼓窦、上鼓室自然通道人工耳蜗植入术的可能性.方法 在4例冰冻成人正常颞骨标本开展新手术入路,并测量相关参数,术后中耳高分辨CT加以证实.结果 所有标本均切开鼓窦,经鼓窦入口、上鼓室、中鼓室放置植入电极,在耳内镜下经外耳道鼓室切开显露蜗窗龛,通过蜗窗植入电极,未损伤鼓索神经、面神经.鼓后峡宽度(4.65...     

中耳手术中的面神经定位

目的结合颞骨解剖和面神经手术，明确适用于手术的面神经解剖标志。方法44具颞骨标本面神经解剖，106例周围性面神经麻痹的面神经减压手术。根据面神经周围的固定解剖标志，确定面神经位置。结果①面神经垂直段标志：水平半规管后中1／3交界处垂直线提示面神经后缘；砧骨短角上缘弧度延长线为面神经垂直段前缘；面神经与水平半规管基本在同一深度；②面神经水平段标志：位于砧骨短突之下；在水平半规管隆突前缘向前上呈30。行走；在匙突后方，面神经与匙突平行形成中上鼓室内侧面交界缘；经过匙突面神经向前上行走到膝状神经节；③膝状神经节定位：从镫骨头到匙突等距离延长线为膝状神经节位置；④鼓索神经定位：鼓索从左侧鼓沟的3点或右侧鼓沟的9点出骨管，沿鼓沟向前行走于砧骨长突外侧和锤骨颈内侧；鼓索神经从面神经发出处距离茎乳孔5—8mm；鼓索位于鼓膜紧张部与松弛部交界处。所有手术所见面神经走向符合解剖所见。结论中耳乳突的固定标志是面神经定位的参照物，其中水平半规管的位置最恒定，根据参照物确定面神经位置提高了手术的安全性。     

The posterior ligament of the incus (“white dot”): A reliable surgical landmark for the facial recess

ObjectiveThere is a void in the literature describing reliable surgical landmarks that aid in the dissection of the facial recess in the absence of skeletonizing the mastoid segment of the facial nerve. The posterior ligament of the incus is a readily distinguishable “white dot” along the incus buttress that has been used to guide dissection in a safe and efficient manner. The goal of our study is to describe a surgical approach that utilizes this surgical landmark to drill the facial recess and to take anatomical measurements demonstrating the safety and reliability of this approach.Materials and methodsAfter cortical mastoidectomies were performed in 10 cadaveric temporal bones, the white dot was identified at the junction of short process of the incus and the incus buttress. Using the white dot for anatomical reference, a 2 mm diamond drill bit was used to open the facial recess without first identifying the facial nerve or chorda tympani nerve. After photographs were taken, the facial and chorda tympani nerves were definitively identified and skeletonized to delineate the confines of the facial recess. Photographs were once again acquired in a consistent manner for comparison. Finally, calibrated anatomic measurements were acquired from the 10 distinct image sets.ResultsThe facial recess was successfully drilled in 10 temporal bones using the posterior ligament as a surgical landmark without injury to the chorda tympani or facial nerve. The median angle taken from the axis of the short process of the incus to the facial nerve - chorda tympani junction was 139.2° (IQR 136.8–141). At the widest point in the facial recess, median distances anterior and posterior to an imaginary line connecting the white dot to the facial nerve - chorda tympani junction were 1.6 mm (IQR 1.5–1.7) and 1.6 mm (IQR 1.6–1.7; p = 0.57), indicating at this point, the white dot reference reliably bisects the facial recess width. Similarly, at the level of the round window niche, median anterior and posterior distances from an imaginary line connecting the white dot to the facial nerve - chorda tympani junction were 1.1 mm (IQR 1.1–1.3) and 1.3 mm (IQR 1.1–1.7; p = 0.07), respectively, once again demonstrating the white dot reliably bisecting the facial recess.ConclusionsThe white dot, representing the posterior ligament of the incus, is a reliable surgical landmark that aids in safe and efficient drilling of the facial recess without first skeletonizing the facial nerve.     

The superior petrosal triangle as a constant anatomical landmark for subtemporal middle fossa orientation

OBJECTIVES/HYPOTHESIS; Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach. METHODS; We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior-lateral lip of the foramen spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy-middle fossa approach to evaluate the consistency of localizing the head of the malleus. RESULTS; We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the foramen spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the foramen spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm). CONCLUSIONS: The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures.     

Surgical anatomy of the temporal bone posterior to the internal auditory canal: an operative approach.

The aim of this study was to describe the anatomical limits of a wedge shaped area of bone lying posterior to the internal auditory canal and to describe the anatomical structures which course through it. One hundred consecutive temporal bones were dissected and topographical dimensions of the posterior wall of the temporal bone were measured along with depth measurements from the posterior fossa wall to the structures of the fundus of the internal auditory canal. A microsurgical technique was then described using the structures within this area as landmarks for specific dissection to the posterior and lateral aspects of the internal auditory canal. Results of 19 tumors have been presented. The status of the facial nerve at the end of surgery and whether or not total tumor removal was possible were discussed.     

Surgical anatomy guidelines for the extended transtemporal approach to the cerebellopontile angle

The extended middle fossa approach to the cerebello-pontine angle was practiced in ten human temporal bones, and the topographical relations of essential structures were studied by exposure of the bony labyrinth. After identification of the greater superficial petrosal nerve and the grey line of the superior semicircular canal landmarks were defined in order to localize the vertical crest (Bill's bar), the ampulla of the superior semicircular canal, the intralabyrinthine part of the facial nerve, the cochlea, and the internal carotid artery. The advantages of the extended middle fossa approach for the preservation of the labyrinthine and cochlear structures together with the safe identification of the facial and cochleo-vestibular nerves are emphasized.     

New method of identifying the internal auditory canal as seen from the middle cranial fossa approach

OBJECTIVES: The middle cranial fossa approach allows one to remove acoustic tumors and preserve the facial nerve and hearing. However, there are no consistent landmarks on the surface of the temporal bone to identify the internal auditory canal. This study was designed to identify the internal auditory canal by use of external and internal references as seen during the middle cranial fossa approach. METHODS: We dissected 32 temporal bones using the middle cranial fossa approach and measured the distances from the posterior origin of the zygomatic arch to an imaginary coronal line between the foramen spinosum and the foramen ovale. We measured the angle between the lines drawn from the posterior origin of the zygomatic root to the foramen spinosum and from the foramen spinosum to the porus of the internal auditory canal. RESULTS: The distances were 14.7 mm and 22.9 mm, respectively, and the angle was roughly 90 degrees. CONCLUSIONS: In this study, we found external and internal landmarks that help to locate the internal auditory canal.     

成人侧颅底临床解剖学研究

目的:通过对侧颅底重要解剖标志的观察与测量.为临床侧颅底手术的定位、导航提供解剖学依据.方法:20具40侧10%甲醛浸泡的成人尸头(黄种人)和20例临床手术患者进行侧颅底指引标志的观察与测量.尸头标本按1～40的顺序进行编号;20侧临床手术患者按1～20的顺序进行编号.结果:通过测量得出侧项底相关定位标志的解剖数据:颈静脉孔静脉部、神经部与颅底重要指引标志的距离;迷路三角、迷路后三角及乳突表面三角的面积;侧颅底手术中面神经主动移位的最大距离.结论:耳科与颅底外科的手术几乎均在深埋于颅(颞)骨的狭窄空间内操作,周围布满了重要的血管和神经,术者了解侧颅底重要标志的定位测量数据有利于手术中安全扩大手术视野,有效避免术中损伤重要血管、神经,最大限度地保留面神经功能,最终提高患者的生存质量.     

Anatomical relationship between the position of the sigmoid sinus, tympanic membrane and digastric ridge with the mastoid segment of the facial nerve

Our study was carried out to examine the relationships of the sigmoid sinus, tympanic membrane and digastric ridge with the mastoid segment of the facial nerve. We studied 33 adult temporal bones. The distances among these structures were evaluated according specific landmarks that can be repeated in a simple manner. We found a good relation, in a proportional and lineal order, between these three structures and the facial nerve. This study indicated a correlation between the position of these three structures and the mastoid segment of the facial nerve through a simple morphometric method.     

Pleomorphic adenoma involving the stylomastoid foramen

A rare case of an intratemporal pleomorphic adenoma is presented and the management of such a tumour is discussed. Some anatomical aspects of the facial nerve, pertinent to the pathophysiology of facial paralysis are outlined. This case demonstrates that tumour extension into the temporal bone can be resected successfully at initial surgery with excellent facial nerve functional outcome. We advocate exploration of the fallopian canal to be carried out at primary surgery and be performed by a surgeon familiar with the surgical anatomy of the intratemporal segment of the facial nerve. This approach will reduce the risk of facial nerve injury and palsy both at surgery and subsequently.