改良的乙状窦前入路应用解剖学研究

Study of Anatomy Related to Modified Presigmoid Approach

目的探讨经岩乙状窦前入路的微创化改良技术操作方法及其优点。方法根据Fukushima观点对传统经岩乙状窦前入路进行微创化改良,并在15例国人成人头颅湿标本双侧分别随机模拟传统经岩乙状窦前入路和改良入路,并进行解剖学比较研究。结果改良的乙状窦前入路手术中,只需磨除少量的岩骨后部骨质,显露乙状窦前方4mm的硬膜区,切开硬膜和小脑幕即可充分显露岩斜区,且其颞枕骨窗面积较传统入路显著缩小(P<0.05),但两者手术最大视角和操作深度无显著差异(P>0.05)。结论改良的乙状窦前入路较传统入路更简便、安全、微创,是岩斜区肿瘤手术治疗的较佳入路。

Objective To explore the improvement of the transpetrosal presigmoid approach in order to reduce its invasiveness. Methods The classical transpetrosal presigmoid approach was modified according to Fukushima＇s opinion. The classical transpectrosal presigmoid approach and the modified approach were simulated in 15 fixed and perfused adult eadaveric heads. The anatomy related to both the approach was compared. Results The petroclival region could be sufficiently exposed by wearing off a small portion of the posterior petrous bone, exposing the 4 mm dura area in front of the sigmoid sinus and incision of the presigmoid dura and cerebellar tentorium. The bone window area at the templeoecipital part of the modified approach was significantly smaller than that of the classic approach （P〈0.05）. There was insignificance difference in the maximal operative visual angle and the depth of the visual field between both the approaches （P〉0.05）. Conclusions This modified approach is simpler, safer and smaller invasive than the classic transpetrosal presigmoid approach and more suitable for surgical treatment of petroelival tumors.