内镜经鼻岩尖手术中序贯性组合式解剖标志的确立

Establishment of sequential combined anatomical landmarks by endoscopic endonasal approach in petrous apex surgery

目的确立内镜经鼻岩尖手术中序贯性组合式的解剖标志。方法通过内镜经鼻入路对3具(6侧)新鲜冰冻尸颅及5具(10侧)福尔马林固定的成人头颅标本进行岩尖区解剖,观察入路过程中的解剖标志并拍照和摄像记录。结果内镜经鼻岩尖手术可按照入路过程分为5阶段,即鼻腔、鼻咽、鼻窦、翼腭窝、岩尖阶段。每一步骤中均可找到一组相对固定、在术中可作为路标的标志,分别为:鼻腔阶段标志、鼻咽阶段标志、蝶窦阶段标志、筛窦阶段标志、上颌窦阶段标志、翼腭窝阶段标志及岩尖阶段标志。结论内镜经鼻岩尖手术可根据术中依次涉及的腔隙,在每个阶段中参照一组解剖标志,而不是单一标志进行下一步操作。参照这些序贯性组合式的解剖标志,可精确和安全地进行内镜经鼻岩尖区手术。

Objective To establish sequential combined anatomical landmarks in transpetrous apex surgery by endoscopic endonasal approach（EEA）.Methods The petrous apex of 3 fresh and 5 formalin-fixed adult cadaveric heads were dissected by EEA.The anatomic landmarks were observed,photographed and videotaped during the surgical procedure.Results The surgical procedure could be divided into 5 phases,namely nasal phase,nasopharyngeal phase,sinus phase,pterygopalatine fossa phase and petrous apex phase.There was a group of relative fixed landmarks in every phase,which could be easily identified to guide the surgery,which were nasal landmarks,nasopharyngeal landmarks,sphenoid sinus landmarks,ethmoidal sinus landmarks,maxillary sinus landmarks,pterygopalatine fossa landmarks and petrous apex landmarks.Conclusions In every phase during transpetrous apex surgery by EEA,there is a group of landmarks rather than a single landmark to guide the surgery.According to the sequential combined landmarks,the transpetrous apex surgery can be performed accurately and safely.