乙状窦前-迷路后锁孔入路的内镜解剖学研究

Endoscopic anatomy of the presigmoid-retrolabyrinthine keyhole approach

目的探讨经乙状窦前-迷路后锁孔入路的内镜解剖学特征,着重讨论内镜下定位的解剖学标识。方法取10具20侧经10%甲醛溶液固定的成人头颅标本,采用耳后"C"形切口,长度约6 cm,模拟乙状窦前-迷路后入路,神经内镜下观察显露的解剖结构。结果骨窗开口前缘与内耳道口后唇距离为(14.0±3.6)mm。通过调整内镜角度,经乙状窦前-迷路后锁孔入路可清晰显示岩斜区脑神经及附近走行血管。结论相对于手术显微镜而言,内镜对周围结构的显露更为广泛。临床实践中,应制定个体化治疗方案,联合使用内镜和显微镜,以充分发挥各自的优势。

Objective To study the endoscopic anatomical characteristics of petroclival region via presigrnoid-retrnlabyrinthine keyhole approach, emphasizing the anatomical landmarks for localization under a endoscope. Methods Ten adult cadaveric heads （20 sides） fixed with 10% formalin were observed. A ＂C＂ shape incision about 6 cm was made at retro-auricular region and the anatomical landmarks were observed on each side using simulated presigmoid-retrolabyrinthine keyhole approach. Results The average distance from the anterior margin of the bone window to the posterior lip of internal acoustic meatus was 14.0±3.6 mm. The petroclival region can be well exposed by adjusting the angle of endoscope. Conclusion The surgical exposure can be more extensively by using endoscope compared to using operating microscope. Individualized treatment should be carried out in surgical therapy for combination of the microscope and endoscope according to need.