额颞经颧弓-颞下手术入路的显微解剖学研究

The study on the microsurgical anatomy of the frontotemporal -zygomatic arch-subtemporal approach

目的对额颞经颧弓-颞下手术入路进行显微外科解剖学研究,为手术入路提供解剖学基础。方法利用10例经福尔马林固定的国人成人尸头共20侧,15例头颅干标本共30侧,对额颞经颧弓-颞下手术人路相关解剖标志进行了详细地显微解剖、观察、拍摄、测量和统计。结果面神经额支与颧支存在变异的可能,离断颧弓的断端间距约30mm,颅板外缘至颧骨前后根夹角处距离约25mm,前后根交点与中颅窝底的夹角为-0．03±2．83(-5．0-4．0)°。与保留颧弓相比,离断颧弓后的骨窗下缘至颞底可缩短15mm左右的距离,与干标本测量颧弓宽度的数据14．76mm相当。海绵窦中段的截面、视神经管和眶上裂的解剖关系相对固定。结论额颞经颧弓-颞下手术入路适用于海绵窦-眶尖区病变,其手术空间和视角非常理想,应根据手术需要酌情采用。

Objective To study the microsurgical anatomy of frontotemporal-zygomatic archsubtemporal approach and provide anatomical basis for operative approach. Methods Ten cases （20 sides） of Chinese adult cadaver heads fixed by 10% formalin and fifteen cases （30 sides） of dry skull samples were studied. The relative anatomical landmarks of the frontotemporal-zygomatic archsubtemporal approach were dissected under microscope, observed, photographed, measured and analyzed. Results The frontal and zygomatic branches of the facial nerve had variations. The distance between the broken tips of the broken zygomatic arch was about 30 mm. The distance from the outer border of the skull to the intersecting point of the anterior and the posterior root of the zygomatic bone was about 25 mm. The angle between the intersecting point of the anterior and the posterior root and the middle skull base was -0.03±2.83 （-5.0～4.0）°. The distance from the inferior border of the bone window to the temporal base was shortened about 15 mm with the zygomatic bone broken, which was correspondent with the width of the zygomatic arch （14.76mm） measured from the dry samples. The anatomical relations between the middle section of the cavernous sinus, the optic canal and the superior orbital fissure were relatively invariable. Condusion The frontotemporalzygomatic arch-subtemporal approach is applicable to the lesions in the cavernous sinus-orbital apex region. The operative space and visual angle of this approach are satisfying. This approach should be chosen with discretion according to the operative need.