颅后窝内外面有关骨性结构的应用解剖学研究

Applied Anatomic Study on the Inside and Outside of Posterior Cranial Fossa

目的:研究与斜坡区、桥小脑角区、及颈静脉孔外侧区手术入路有关的骨性结构,探讨其定位解剖和临床意义。方法:20具干性成人头颅标本,移去颅盖骨,观察、测量颅后窝内外面有关骨性结构。结果:硬脑膜窦角(STP)点距内耳门距离左侧(32.99±2.72)mm、右侧(37.84±2.58)mm,距颈静脉孔距离左侧(35.27±3.25)mm、右侧(34.63±3.25)mm。颈静脉孔上方约5mm为内耳门,下方约20mm为舌下神经管内口,前方为斜坡区。内耳门、颈静脉孔、舌下神经管内口三者近似在一条直线上。乳突尖距颈静脉孔距离左侧(22.62±1.90)mm、右侧(22.33±2.30)mm,距枕髁后外缘距离左侧(29.42±2.15)mm、右侧(29.08±2.29)mm,距枕大孔距离左侧(39.39±2.03)mm、右侧(38.47±1.96)mm。结论:STP点、颈静脉孔、内耳门是颅后窝内面重要骨性结构,乳突是颅后窝底外侧一个重要骨性标志结构;STP点、内耳门、颈静脉孔、乳突尖可作为颅后窝手术重要的定位标志。

Objective：To study the bone structures of clival, cerebellopontine angle and outer jugular fommen regions on operative approach, in order to identify the important landmarks, and to prevent unnecessary morbidity. Methods： Some important bone structures of the inside and outside of posterior cranial fossa were observed and measured in 20 cadaveric skulls whose cranium had been removed. Results： The distance of STP point （ i. e. confluence of sigmoid sinus, transverse sinus and superior petrosal sinus） to internal acoustic pore were （ 32.99±2.72） mm and （ 37.84 ± 2.58 ） mm, to jugular fommen were （ 35.27 ± 3.25 ）mm and （ 34.63 ± 3.25 ） mm, in left and right side respectively. Internal acoustic pore was above the jugular fommen nearly 5 mm, and the inter entrance of hypoglossal canal was under the jugular fommen about 20mm, moreover, the three parts were nearly in one line. The clival region was ahead of the jugular fommen. The distance of mastoidale to jugular fommen were （ 22.62 ± 1.90 ）mm and （ 22.33 ± 2.30 ） m, to the outer-posterior margin of occipital condyle were （ 29.42 ± 2.15 ） mm and （ 29.08 ± 2.29 ） mm, to fommen magnum were （ 39.39 ± 2.03 ） mm and （ 38.47 ± 1.96） mm, in left and right sides respectively. Conclusions ： The STP point , jugular fommen and internal acoustic pore were important bone landmarks in internal posterior cranial fossa. Mastoid process was a very important bone landmark in outer posterior cranial fossa. So, the STP point, internal acoustic pore, jugular fommen and mastoidale were very important landmarks for operative approach in the posterior cranial fossa.