改良岩斜区手术入路的解剖学研究

Modified surgical approaches to the petroclival region: an anatomic study

目的改进岩斜区手术入路,使其更简单、微创。方法对20例10%甲醛固定的国人成人头颅湿标本和10例漂白颅骨干标本模拟乙状窦后经内听道上嵴入路和颞下经岩骨嵴入路行手术操作,对手术涉及的重要结构进行测量、拍照;手术前后对湿标本进行CT岩骨薄扫,对重要结构进行测量、拍照。结果乙状窦后经内听道上嵴入路涉及的重要结构有岩静脉、内听动脉、内听道上嵴等;重要参数包括岩尖骨质最大磨除范围前后径、横径。颞下经岩骨嵴入路涉及的重要解剖结构包括Labbe静脉、岩骨内部结构、脑干腹侧间隙等;重要参数包括岩骨嵴磨除范围。结论乙状窦后经内听道上嵴入路通过颅后窝开颅,磨除岩尖骨质,可切除颅中窝部分的肿瘤,适用于主体在颅后窝的岩斜脑膜瘤。颞下经岩骨嵴入路通过对岩骨嵴的磨除,增加了对岩骨背侧肿瘤基底的暴露,适合切除各型岩斜区脑膜瘤。

Objective To study the surgical approach to the petroclival region for simple and minimally invasive procedures. Methods Micro-invasive operation approaches to petroclival region were performed via retrosigmoid trans-supramental approach (RTA) and subtemporal transpetrosal ridge approach (STA) respectively on 20 adult cadaver heads fixed by 10% formalin and 10 dry human skulls. All the cadaver heads were examined by bone-window CT scanning before and after operation. Important anatomic structure and position relationship were measured and photographed. Results For the RTA, the important structures include petrous vein, inner audition artery and suprameatus. The important data include the scope of the bone window. For the STA, the important structures include vein of Labbe, petrous bone and brain stem ventral space. The important data include the drilling scope of the petrous ridge. Conclusion For the RTA, it is original to suggest the petrous apex maximum drilling scope, through which the middle fossa part of the tumor could be removed, and the indication was the type Ⅱ petroclival meningiomas. For the STA, it is an original approach to resect all types of petroclival meningiomas by the petrous ridge drilling.