颞肌解剖及翼点手术入路中的保护措施

An anatomical study on protecting temporal muscle in pterional craniotomy

目的:研究颞肌的解剖特点,为翼点入路中颞肌的保护提供方法。方法暴露颞肌的肌纤维和血管、神经,观察和测量颞肌的肌纤维和血管、神经的解剖数据。结果:颞肌起自颞窝,向下逐渐集中,在颧弓深面移行为强大的肌腱,止于喙突的内侧面、尖部、前后缘和下颌支的前缘,颞肌长(10.5±1.6)cm,宽(8.4±1.5)cm,前下区最厚可达9.3mm,后区最薄只有2.2mm。营养颞肌的动脉是颞深前、后动脉和颞中动脉。颞肌的神经有来自下颌神经的颞深前神经、颞深后神经和颞中神经。结论:在翼点入路中,保护颞肌的措施:①保护颞浅动脉;②筋膜下解剖,保护面神经;③暴露中颅底时断开颧弓可减少颞肌的牵拉;④在骨膜下逆行解剖颞肌,可保护颞肌深部的神经和血管;⑤在上颞线剥离颞肌,术末把颞肌直接固定于颅骨上,保持适当的肌张力。

Objective： To investigate the anatomical characters of the temporal muscle （TM） and find some ways to preserve TM. Methods： Arteries and nerves of TM in 10 cadaveric skull specimens were observed and measured. Results： TM, originated from the temporal fossa, passed zygomatic arch and inserted into the coronoid process and anterior ramus of the mandible. It was 10.5±1.6 cm long, 8.4±1.5 cm wide. Its thickest anterior part was 9.3 mm, and thinnest posterior part was 2.2 mm. The muscle was nourished by the anterior and posterior deep temporal arteries and the middle temporal artery. TM had three nerve branches： the anterior deep temporal nerve, posterior deep temporal nerve and middlel temporal nerve. Conclusion： Some measures for to protecting TM in pterional craniotomy are as follows, ① preserve the superficial temporal artery; ② prevent injury to the facial branches by using sufascial dissection;③decrease the traction TMby zagomatic osteotomy; ④ dissect the muscle in subperiosteal retrograde fashion to preserve the deep vessels and nerves; ⑤ dissect the muscle from the superior temporal line for reattaching the muscle directly to the bone.