侧颅底的矢状和冠状断层解剖及临床意义

目的为侧颅底病变的影像诊断及手术入路提供解剖学基础。方法选取成人尸体头颈部40例,分别作矢、冠状断层解剖。在经颈动脉管垂直段、卵圆孔矢状层面上和经卵圆孔、茎突根部冠状层面上,观察侧颅底结构的解剖学关系,利用游标卡尺测量侧颅底内重要结构的径线及结构之间的距离。结果侧颅底的矢、冠状断层可清晰显示卵圆孔、颈静脉孔、颈动脉管垂直段、颈静脉窝、颞下颌关节、茎突等侧颅底结构及其毗邻关系和咽旁间隙内的结构,颈动脉管外口、卵圆孔和茎突根部至颈静脉孔的距离分别为(16.60±2.34)、(22.70±1.64)、(21.14±2.05)mm。茎突是侧颅底影像诊断及手术入路时观察各结构间的位置关系和寻找神经、血管的骨性标志。两侧侧颅底结构呈对称性分布,重要结构的径线及结构之间的距离均无显著性差异。结论侧颅底的矢、冠状断层是分别显示内耳道内结构和颞下间隙的最佳断层影像方式,对侧颅底病变的影像诊断和设计手术入路等具有重要意义。

Sagittal and coronal sectional anatomy and clinical significance of the lateral cranial base

Objective　To provide anatomical basis for imaging diagnosis and surgical approach of the diseases of lateral cranial base.　Methods　40 headneck specimens from adult corpses were selected and cut into the sagittal and coronal sections respectively. On sagittal sections through the vertical part of carotid canal, foramen ovale, and on the coronal section through the foramen ovale and root part of styloid process, anatomical relationship of the structures of lateral cranial base were observed, and measured about anatomic parameters among the important structures of lateral cranial base with the vernier caliper.　Results　The sagittal, coronal sections could clearly display the foramen ovale, jugular foramen, vertical part of carotid canal, jugular fossa, temporomandibular joint, styloid process of lateral cranial base and its adjacent structures, and the structures in parapharyngeal space of the lateral cranial base. The distance from the external opening of carotid canal, foramen ovale, root part of styloid process to the jugular foramen were 16.60±2.34 mm, 22.70±1.64 mm, 21.14±2.05 mm in sagittal and coronal section respectively. Styloid process was bony mark for observing relationship among the structures and searching the nerve and vessels during the imaging diagnosis and surgical approach of the lateral cranial base. The structures of lateral cranial base were symmetrical of both sides, and there were no significant differences in the diameter and distance between the important structures. Conclusions　 It's better to show structures in the internal acoustic meatus and infratemporal space, and valuable references for imaging diagnosis and planning surgical approach of the diseases of lateral cranial base, under the sagittal and coronal sections separately.