颞下-经岩前入路的显微外科解剖学研究

目的 模拟颞下-经岩前入路，对中颅窝底硬膜内外各个结构的解剖关系进行研究，并探讨改良的可行性。方法 本组采用8例福尔马林固定的尸头，磨除颞骨岩部外侧三角、颞骨岩部前方Kawase菱形区、内侧岩尖三角的骨质，测量各靶点间距离及显露角度，用手术显微镜观察岩斜区、视交叉后区。结果 （1）颞骨岩部外侧三角可磨除面积2．8cm^2，深度可达2．26cm；（2）颞骨岩尖前面、上面可磨出面积约2．5cm^2、1．7cm^2的骨窗。结论 （1）颞下-经岩前入路改良了经典的颞下入路，可在不损伤听力的基础上减少对颞叶的损伤，更能显露病变。（2）本研究进一步磨除了颞骨岩部外侧三角，扩大了手术操作范围，改善了对视交叉后区的视野。

Microsurgical anatomic study of subtemporal-anterior transpetrosal approach

Objective To study topography of interior and external dura mater of the middle cranial fossa through subtemporal-anterior transpetrosal approach under a microscope, and discuss the feasibility of improving the approach. Methods 8 adult cadaveric heads fixed in formalin were used, with the bones milled away in the lateral triangle of the petrous bone, Kawase rhombus and the inside triangle ofpetrous apex. The distances between the targets as well as the angles were measured and then the exposed petroclival and retrochiasmatic areas were observed under microscope. Results The lateral triangle of petrous part of temporal bone were milled away deep to 2.26 cm at a size of 2.8 cm2. The anterior and superior petrous apex of the temporal bone was windowed by milling with an area of 2.8cm2 and 1.7 cm2, respectively. Conclusion The subtemeporal anterior transpetrosal approach, as an improved subtemporal approach, can expose the lesions optimally, thus resulting in no injuring the hearing and reducing injuries to temporal lobe. On the other hand, the lateral bone of petrous part of temporal bone is removed so as to improve the view to retrochiasmatic area and expand operative field.