前颞下锁孔入路开放脑神经池至上岩斜区的显微解剖

Opening cranial cisterns in anterior subtemporal keyhole approach to superior petroclival region：anatomic study and comparative analysis

目的定量对比分析在前颞下锁孔入路中开放脑神经池前后至上岩斜区的显露面积和操作角度。方法采用导航工具，在20侧尸头标本上，测量并对比开放脑神经池前后上斜坡、脑干腹外侧显露面积，后岩床襞、基底动脉（BA）显露长度以及至BA顶端的操作角度。结果开放脑神经池后上斜坡、脑干腹外侧显露面积为（136．7±19．8）mm^2、（222．8±25．8）mm^2；后岩床襞、BA显露长度为（11．5±0，6）mm、（10．3±2．0）mm以及至BA顶端的垂直操作角度（13．7±1．7）°，均有显著增加（P〈0．05）。至BA顶端的水平操作角度前后无显著增加（P〉0．05）。结论开放脑神经池后能够增加上岩斜区的显露面积和操作角度。

Objective To quantitatively compare the exposure areas and angles in anterior subtemporal keyhole approach to superior petroclival region before and after cranial cisterns opening. Methods The study was carried out on 20 sides of cadaver heads. With application of a navigation system, the exposure area in superior clivus, the ventrolateral area in brain stem around BA, the linear exposure of the posterior petroclinoid fold and BA trunk, and the approach angles to BA tip were evaluated. Results The exposure area in superior clivus （ 136. 7 ± 19. 8 ） mm^2, the ventrolateral area in brain stem （ 222. 8 ± 25.8 ） mm^2, the linear exposure of the posterior petroclinoid fold （ 11.5 ±0. 6 ） mm, and BA trunk （10. 3± 2.0 ）mm, and the approach angles in the vertical axis to BA tip（ 13.7 ± 1.7 ）°were significantly greater after opening cranial nerve cisterns. But the approach angles in the horizontal axis to BA tip were indifferent. Conclusions The exposure areas and angles of anterior subtemporal keyhole approach to superior petroclival region can be increased after opening cranial nerve cisterns.