经乳突联合枕骨髁外侧入路切除颈静脉球部位病变的临床解剖

Clinical anatomy of the transmastoid lateral approach combined with transjugular process for exposing glomus jugulare

目的:探讨切除颈静脉球部位病变的手术入路,为手术提供解剖学标志及依据。方法:11具(22侧)成人头颅标本,其中10具(20侧)经10%福尔马林固定湿标本,1具(2侧)新鲜标本,在手术显微镜下模拟经乳突联合枕骨髁外侧入路颈静脉球的手术,观察手术入路中主要结构及颈静脉球部位的暴露情况。结果颈静脉球顶到后半规管之间的距离(4.78±3.46)mm;面神经垂直段到颈内动脉膝部的距离(13.46±3.66)mm;面神经管垂直段中点到乙状窦前壁距离为(6.30±2.75)mm.应用该入路暴露颈静脉球部位,可以显示颈静脉球内侧壁的后组脑神经与血管。半规管、颈静脉球、面神经管、乙状窦,枕骨颈静脉突及寰椎横突是该手术入路中的主要标志。结论:经乳突联合枕骨髁外侧入路切除颈静脉球部位病变,能够提供良好的视野,利于保留面神经功能及后组脑神经功能。

Objective： to provide anatomic data for transmastoid lateral approach combined with transjugular process for exposing glomus jugulare. Methods： transmastoid lateral approach combined with transjugular process was simulated in 10 adult cadaveric specimens （20 side）. The main anatomic marks of the surgical approach was studied, and the distance between the important structures to the glomus jugulare was measured. Results： The distance between the glomus jugulare to the posterior semicircular canal, the vertical portion of the facial nerve to the lap of the internal carotid canal and facial nerve to the sigrnoid sinus were 4.78±3.46mm, 13.46±3.66mm and 6.30±2.75mm seperately, the semicircular canal, the glomus jugulare, facial canal, the sigmoid sinus, the processus jugularis ossis occipitalis and the processus transverses of C1 were the main marks. Conclusions＂ The transmastoid lateral approach combined with transjugular process give us a better exposure to the glomus jugulare. It is hopeful to protect function of the facial nerve and the post-cranial nerve.