乙状窦后进路内窥镜手术解剖学研究

目的：为乙状窦后进路相关内窥镜手术提供解剖学依据。方法：测量30例干颅骨表面标志位置关系，准确定位乙状窦后进路骨窗；利用10具甲醛固定成年头标本模拟内窥镜下乙状窦后进路，验证其可行性。结果：(1)以星点至乳突点连线中点为中心作直径2．0cm的骨窗适于暴露桥脑小脑角区结构；(2)内镜下乙状窦后进路可在尽量减少压迫小脑的情况下充分暴露桥脑小脑角区神经、血管等重要结构。结论：精确定位乙状窦后进路骨窗能够最大限度减少牵托小脑，对临床开展锁孔手术有指导意义。

An anatomic study on postsigmoid approach via endoscope

Objective: To observe the spatial relationships between main blood vessles and nerves in the cerebellopontine angle area and provide anatomic basis for lateral and posterior skull base minimal invasive surgery via endoscopic retrosigmoid keyhole approach. Methods: Thirty dried adult skulls were used to measure the spatial relationships among the surface bony marks of posterior cranial fossa and locate the most appropriate drilling area for retrosigmoid keyhole approach. 10 fomalin-fixed adult cadaver specimens were used for simulating endoscopic retrosigmoid approach to determine the visible scope. Results: (1) The midpoint between the mastoid tip and the asterion was the best drilling point for retrosigmoid approach. Making a hole of 2.0cm on the center of this point was suitable for exposing the related structures in the cerebellopontine angle. (2) Endoscopic retrosigmoid approach can decrease the pressure to the cerebellum and expose the related structures effectively. Those structures included facial nerve, vestibulocochlear nerve, trigeminal nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, hypoglossal nerve, anterior inferior cerebellar artery, posterior inferior cerebellar artery and labyrinthine artery etc. Conclusions: Exact location on endoscope retrosigmoid approach can avoid dragging cerebellum during the minimal invasive surgery. The application of retrosigmoid keyhole approach will extend the application of endoscopic technology.