不同类型乙状窦前经岩骨入路对岩斜区暴露范围的量化比较研究

目的量化对照研究不同类型乙状窦前经岩骨入路对岩斜区的暴露范围,为临床手术的入路选择提供理论依据。方法对7例(14侧)尸头进行迷路后、经迷路和经耳蜗入路的手术模拟操作,运用神经导航技术对各入路的岩斜区暴露范围进行量化比较。同时对各入路可能导致的神经功能损害进行观察。结果经迷路后入路能保留面听神经功能,但对岩斜区的显露范围较小,明显小于经迷路入路和经耳蜗入路。后两者的显露范围无显著性差异,但均可能引起面神经功能损害和听力丧失。结论经岩骨入路可获得良好的岩斜区显露,但手术创伤大,应谨慎选择。经迷路入路可获得满意的手术显露,但直接损害听力,只适用于术前听力已经丧失的病人。经耳蜗入路手术创伤太大,一般没有必要。对于手术前存在听力的病人,迷路后入路是最佳选择。

The quantities comparison of the exposure to petroclival region by different transpetrosal approaches

Objective To provide a scientific basis for the selection of surgical approach, the quantities comparison of the exposure to petroclival region by different transpetrosal approaches was performed. Methods The retrolabyrinthine, translabyrinthine, and transcochlear approaches were performed in succession on 7 latex-injected cadaver heads (fourteen sides), in which neuronavigation was used to quantify and compare the areas of exposure to petroclival region by different approaches, meanwhile to observe the correlated morbidity of cranial nerves caused by these approaches. Results The retrolabyrinthine approach reserves hearing and facial function but provides for only a small exposure. This is significantly less than with the translabyrinthine and transcochlear approaches. Moreover there is no significant different between the later two approaches, both of them may lead to deafness and dysfunction of facial nerve. Conclusion The transpetrosal approach can offer excellent exposure to the petroclival region but should be used judiciously due to the high level of morbidity of surrounding injury. For patient without hearing preoperatively, the translabyrinthine approach is optimal choose profiting from its greater exposure. The transcochlear approach is too invasive to be used as a routine. The retrolabyrinthine approach is the best option for patients with hearing.