摘要
目的通过颞下经小脑幕入路和经岩骨乙状窦前入路至岩斜区的显微解剖学研究，探索2种入路的适用范围，为临床上岩斜区手术入路的选择提供参考依据。方法在10具（20侧1完整湿性成人头颅标本上模拟颢下经小脑幕入路和经岩骨乙状窦前入路，观察岩斜区颅神经、血管的走行特点，神经和血管间及其与周围结构间的显微解剖关系，明确2种入路所暴露的视野范围。结果滑车神经自后床突后外方（15．72±3．81）mm处穿入小脑幕游离缘．在幕中潜行约（6．82±1．81）mm后进入海绵窦外侧壁。小脑幕剪开后显露的上界平后床突、后交通动脉水平，下界平岩骨嵴范围内的病变。岩骨乙状窦交叉点到后半规管最后部的距离约（10．48±0．42）mm，Trautman三角区的面积平均为（243．5±26．1）mm2。经岩乙状窦前入路可显露上达海绵窦后部、Meckel’s腔、鞍背，内至对侧斜坡，下至桥延沟及延髓腹侧的上段。结论颞下经小脑幕入路主要适用于上、中斜坡及岩骨尖的病变，对下岩斜区暴露不良，手术中需要上抬颞叶，可能会损伤Labbe静脉。经岩骨乙状窦前入路可适用于上、中、下斜坡和岩骨尖的病变，较颞下经小脑幕入路具有牵拉脑组织轻、显露广的优点，但是术中创伤重及操作时间长，可能会引起听力障碍及脑脊液漏。
Objective To study the microscopic anatomy of the petroclival region through simulated subtemporal transtentorial and transpetrosal presigmoid approaches, and discuss their respective scope for clinical application and provide reference to petroclival region surgical approaches. Methods Ten wet adult head specimens （20 sides） were studied by subtemporal transtentorial and transpetrosal presigmoid approach under microscope, respectively; the features of vessels and nerves of the petroclival area, microanatomic relations of vessels and nerves with their surrounding structures were researched; the exposure scope of these two operative approaches to petroclival region was described, Results The trochlear nerve entered the edge oftentorium in post-lateral posterior clinoid process with a mean distance of （15.72±3.81） mm, and it sneaked （6.82± 1.81） mm in the tentorium into the extemal wall of the cavernous sinus. When the tentorium was cut off, it could expose the posterior clinoid process and posterior communicating artery at upper bound, petrous sigmoid sinus junction to the posterior and petrous ridge at lower bound. The distance from semicircular canal was about （10.48±0.42） mm, Trautman＇s triangle could be exposed about （243.5±26.1） mm2. The rear of the cavernous sinus, Meckers cavity and saddle back at upper bound, the contralateral slopes at the inside, and the bridge of groove and ventral medulla oblongata at lower bound could be reached via transpetrosal presigmoid approach. Conclusions Subtemporal transtentorial approach mainly applys to the upper, middle parts of slopes and petrous apex lesions; the temporal lobe needs to be lifted in the operation, which may damage Labbe vein. Transpetrosal presigmoid approach can be applied to superior, middle and inferior slope and petrous apex lesions, it has advantage of light pulling brain tissues and wide exposure than subtemporaltranstentorial approach; however, intraoperative trauma and long operation time may cause hearing impairment and
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2016年第7期690-694,共5页
Chinese Journal of Neuromedicine
关键词
颞下经小脑幕入路
经岩骨乙状窦前入路
岩骨斜坡区
显微解剖研究
Subtemporal transtentorial approach
Transpetrosal presigmoid approach
Petroclival region
Microscopic anatomy
