不同解剖入路显露颈静脉孔区的定量研究

目的定量研究枕下远外侧入路及耳后经颞入路对颈静脉孔区的显露程度,为临床个体化选择手术入路、保护重要结构功能提供可靠的解剖依据。方法选择经10％福尔马林固定的成人头颈湿标本各12具（24侧）,采用枕下远外侧入路及耳后经颞入路进行解剖学研究,用脑立体定向仪测定各步骤颈静脉孔区的显露面积,用游标卡尺测量斜坡和三叉神经的显露长度。结果在远外侧入路中,磨除颈静脉突、部分磨除枕髁后对颈静脉孔区显露程度显著增加;在耳后经颞入路中,迷路后入路、部分磨除迷路对颈静脉孔区的显露程度显著增加。结论磨除颈静脉突是枕下远外侧入路显露颈静脉孔的关键;迷路下入路和部分磨除迷路入路是自侧方显露颈静脉孔区的理想手术入路。

Quantitative analysis of the exposure of suboccipital far-lateral approach and postauricular transtemporal approach to the jugular foramen region

OBJECTIVE: To study the exposure of suboccipital far-lateral approach and postauricular transtemporal approach to the jugular foramen region based on quantitative measurements, and provide reliable anatomic data for selecting surgical approach individually and protecting the function of important structures. METHODS: The complete approach of the suboccipital far-lateral approach and the postauricular transtemporal approach were reproduced in twelve (twenty-four sides) head-neck specimens of adults be fixed in 10% formalin. The exposure area to the jugular foramen region was obtained using a stereotactic device, and the length of exposure of the clivus and the trigeminal nerve were measured using a vernier caliper. RESULTS: In the suboccipital far-lateral approach, the significant increase in exposure was noted after removal of the jugular process and partial resection of occipital condyle. In the postauricular transtemporal approach, the exposure increased significantly after complete retrolabyrinthine approach, partial labyrinthectomy and transcochlear approach. CONCLUSIONS: Resection of jugular process is the key to expose the jugular foramen through the far-lateral approach. The infralabyrinthine approach and the partial labyrinthectomy approach are ideal approaches to expose the jugular foramen region laterally.