内镜辅助下经乳突颈静脉球手术入路的显微解剖

Micro-anatomy of the transmastoid endoscopy-assisted jugular foramen surgery

目的探讨颈静脉球部位的手术入路。方法应用15具（30侧）成人头颅标本，模拟内镜辅助下经乳突颈静脉球手术，观察手术入路中主要结构及颈静脉球部位的暴露情况。结果颈静脉球到面神经垂直段的距离为（3．58±1．32）mm；颈静脉球前壁到面神经垂直段的距离为（5．07±2．93）mm；颈静脉球顶到后半规管距离为（4．68±3．47）mm；颈静脉球顶到鼓室底壁的距离为（O．14±4．32）mm。30例颞骨标本中，5例颈静脉球顶位于鼓室下方，面神经垂直段前方；16例位于面神经垂直段内侧鼓室后方，面神经位于颈静脉球顶部的中间位置；7例位于鼓室和面神经后：2例位于面神经前鼓室底壁内侧接近内耳道下壁。应用内镜辅助能够在面神经垂直段后暴露颈静脉球部位。清楚的显示颈静脉球内侧壁的后组颅神经与血管，并且能够显示脑神经出颅进入颈静脉球的部位。结论内镜辅助下经乳突入路切除颈静脉球部位病变，损伤较小，利于保留面、听神经功能及后组脑神经功能。

Objective To study the surgical approach of the jugular foramen and the clinical anatomy of the transmastoid endoscopy-assisted jugular foramen surgery. Methods The transmastoid endoscopy-assisted jugular foramen surgery was simulated in 15 adult cadaveric specimens （30 side）. The main anatomic mark in the surgical approach was studied ,and the distance between the important structure to the glomus jugular has been measured. Results The distance between the glomus jugular and the vertical segmental of the facial nerve , the anterior wall of the glomus jugular to the facial nerve,the glomus jugular to the posterior semicircular canal and tympanic cavity were （3.58 ± 1.32）mm, （5.07±2.93）mm, （4.68 ± 3.47）mm and （0.14 ± 4.32）mm. In 30 cases, the top of the glomus jugular inferior the tympanic cavity in 5 cases, 7 cases behind the facial nerve and the tympanic, 16 cases the facial nerve is in the middle of the glomus jugular. 2 cases is near the inferior wall of internal auditory meatus .the cranial nerve and blood vessel in the jugular foramen is clearly to be show. Conclusion It is a sample and little damaged way to use the transmastoid endoscopy-assisted jugular foramen surgery and it is hopeful to protect function of the facial nerve, acoustic nerve and the postcranial nerve.