神经导航在Kawase手术入路中的应用

Application of neuronavigation in modified Kawase approach

目的评价神经导航下改良Kawase手术入路的科学性、实用性。方法用本手术入路暴露海绵窦及岩斜区解剖结构,用神经导航技术定位岩骨内部结构,如耳蜗、颈内动脉岩段、内耳道等,最大限度磨除岩尖,暴露斜坡鞍后区,上、中斜坡区等结构;并与该区常用手术入路比较,对其安全性、实用性进行研究。结果神经导航下改良Kawase手术入路,可完全暴露神经膈,通过神经膈上的手术三角可对海绵窦内外病变进行直视手术;通过Meckel腔的打开,可切除Meckel腔内肿瘤,向中、后颅窝或向海绵窦扩展的各型肿瘤;在神经导航下,可安全磨除岩尖,最大范围暴露桥小脑角、斜坡鞍后区、上、中斜坡区等结构。结论在神经导航下改良Kawase手术入路,科学、安全、实用,能最大程度暴露蝶岩斜区病变。

Objective To evaluate the safety and feasibility of the modified Kawase approach under neuronavigation. Methods Bilateral stepwise dissections were performed on formalin-fixed and dye-injected cadaveric heads according to the approach with the aid of neuronavigation to expose the structures of the cavernous sinuses and petroclival regions and to locate cochlear, petrous segment of ICA and IAM, which were compared with conventional surgical approaches. Results This approach provided a direct visualization for the lesions inside or outside the cavernous sinus, the tumors in Meckel＇s cave could be removed by opening this cave and extending the operative exposure towards medial postetior directions. Under neuronavigation, managing the tumors located in CPA, the upper or middle clivus and postosellar region was easy and safe. Conclusion Infracranial procedure with modified Kawase approach under neuronavigation is reasonable, safe and practical, by which the lesions in the sphenopetroclival region can be exposed to the maximal extent.