额颞眶-颧弓开颅显露基底动脉及岩骨斜坡区显微外科解剖

目的：利用额颞眶颧弓（FTOZ）开颅，结合深部骨切除对基底动脉及岩骨斜坡区的显露进行研究。方法：利用10例尸体标本20侧FTOZ开颅，在手术显微镜下切除前后床突，用于显露基底动脉上部；切除岩骨前部用于显露岩骨斜坡区。结果：单纯FTOZ开颅可良好显露基底动脉顶端，结合前后床突切除，在10例标本16侧开颅均成功显露基底动脉中段以上；颞下硬膜外切除岩骨前部（Kawase三角）可由中颅窝显露桥脑前外侧的岩骨斜坡区；在50%(10侧)的情况下其显露可低至基底动脉下端及椎动脉汇合处。结论：FTOZ开颅较常规颞下开颅的手术方向更趋前后，正确选择开颅侧别，结合前后床突切除，FTOZ开颅可用于处理基底动脉中段以上的动脉瘤；结合岩骨前部切除可用于夹闭小脑前下动脉动脉瘤等；对同时累及海绵窦及后颅窝的肿瘤，FTOZ开颅也是全切肿瘤的良好选择。

Frontotemporal orbitozygomatic craniotomy to expose the basilar artery and the petroclival region:microsurgical anatomy

Objective To study the exposure of basilar artery and petroclival region by frontotemporal orbitozygomatic (FTOZ) craniotomy and combined with deep osteotomies. Methods FTOZ craniotomies were performed on 20 sides of 10 cadevric specimens, with the help of surgical microscope, the anterior and posterior clinoidectomies were performed to the upper part of the basilar artery, the removal of the anterior part of the petrosal bone was used to the petroclival region. Results Merely FTOZ craniotomy could well expose the basilar tip region. In combination with the anterior and posterior clinoidectomies, basilar artery upper to its midpoint was successfully exposed in 16 craniotomies of all 10 specimens. To drill away the anterior part of the petrous bone (Kawase's triangle) subtemporaly and extradurally, the exposure could be extended to the petroclival region anterolateral to the pons through middle cranial fossa, in 50% of the craniotomies (10 sides) the exposur could arrive at as low as the lower part of the basilar artery and the convergence of the vertebral arteries. Conclusions In comparison with conventional subtemporal cranitotmy, FTOZ craniotomy holds a more antero-to posterior direction, with correct choice of the side of the craniotomy, it could be used to deal with basilar aneurysms upper to the midpoint of the basilar artery. Incorporated with the anterior petrosectomy, it also could be used to clip the anterior inferior artery cerebellar artery aneurysms. For total removal of the tumors involving the cavernous sinus and posterior cranial fossa simultaneously, FTOZ craniotomy is also a good choice.