内镜辅助的乙状窦前-迷路后锁孔手术入路的解剖学研究

The anatomic study of the endoscope-assisted presigmoid-retrolabyrinthine keyhole approach

目的:研究内窥镜辅助下乙状窦前-迷路后锁孔手术入路的相关解剖,为临床应用提供参考。方法:取15具30侧经福尔马林固定成人头颅标本,模拟乙状窦前迷路后手术,内窥镜下观察颅内相关解剖,测量入路相关数据。结果:岩上窦-乙状窦交点至Meckel’s囊、Dorelle’s管、内耳门、舌咽神经、舌下神经、椎动脉的距离分别为(38.41±2.49)mm(31.18～45.14mm),(48.65±2.94)mm(44.78～56.78mm),(27.32±2.55)mm(23.76～33.00mm),(31.16±3.20)mm(22.38～36.90mm),(43.71±2.54)mm(39.64～49.46mm),(48.10±2.90)mm(42.20～54.56mm)。内窥镜经小脑外侧间隙可顺利到达桥小脑角和脑干腹侧前方,清晰显示颅神经及其附近走行的血管。结论:内窥镜在桥小脑角的应用可弥补手术显微镜的不足,对显微外科手术起到重要的辅助作用。

Objective： To provide anatomic data for the endoscope-assisted presigmoid-retrolabyfinthine keyhole approach. Methods： In 15 cadaveric specimens （30 sides）, the operation of the presigrnoid-retrolabyrinthine approach was simulated. The anatomic features concerning with the approach were observed with the help of endoscopes and microscope. The anatomic measurements correlated with the approach were performed. Results： Distances from the junction of the sigmoid sinus and superior petrosal sinus to the Meckel＇s cave, Dorelle＇s tube, internal auditory foramen, glossopharyngeal nerve, hypoglossal nerve and vertebral artery were （38.41±2.49） mm （31.18～45.14 mm）, （48.65±2.94） mm （44.78～56.78 mm）, （27.32±2.55） mm （23.76～33.00 mm）, （31.16±3.20）mm（22.38～36.90 mm）, （43.71±2.54） mm （39.64～49.46 mm） and （48.10±2.90） mm（42.20～54.56 mm） respectively. Through this approach, cranial nerves and vessels in the cerebellopontine angle and anterior aspects of brainstem were displayed clearly via endoscopes, while the anatomic structures were recognized correctly and the line in the deep field was improved. Conclusions： The disadvantages of microscope can be overcome with the help of the endoscopes during the operation, therefore the microneurosurgery can be improved by its helping.