颞下经岩骨嵴入路的应用解剖学研究

Anatomic research of the subtemporal transpetrosalridge approach

目的提出颞下经岩骨嵴入路切除岩斜区脑膜瘤的方法,使手术更加简便、安全、微创,以替代各型联合入路,降低手术致残、致死率。方法10%甲醛固定的国人成人头颅湿标本10例、漂白的颅骨干标本10例,模拟手术操作并对手术涉及的重要结构测量、拍照;手术前后共10例20侧标本进行CT岩骨薄扫,并对重要结构进行测量、拍照。结果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。结论颞下经岩骨嵴入路通过对岩骨嵴的磨除,增加对岩骨背侧肿瘤基底的暴露,适合切除骑跨中后颅窝的岩斜脑膜瘤。该入路具有操作简单、创伤小、安全性高的特点。

Objective Subtemporal transpetrosal ridge approach (STA) was introduced to remove the petroclival meningiomas with the simple, safe and minimal invasive character. It is suggested to replace the combined approach to reduce the morbidity and mortality. Methods Surgical anatomic study was done on 10 adult cadaver heads fixed in 10% formalin and 10 dry skulls. Ten cadaver heads were examined by bone-window CT scan pre and post-operation. The relationships of important anatomic structures and positions were measured and photographed. Results For the STA, the important structures include Vein of Labbe, petrous bone and brain stem ventral space. The important data include the drilling space of the petrous ridge. Conclusions STA is an original approach to remove petroclival meningiomas. By drilling the petrous ridge, it allows the resecion of the tumor simple, safe and minimal invasive. It is suggested to replace the combined approach with STA to diminish the morbidity and mortality.