颞下经岩骨至岩斜区显微解剖学研究

Microsurgical anatomy of the subtemporal transdural approach to the petroclival region

目的 界定硬膜下磨除岩骨的安全范围,探索岩骨切除方法.方法 福尔马林固定成人头颅湿标本10例（20侧）.模拟颞下经岩骨手术入路,观察岩骨磨除前后的显露范围及周围重要结构的解剖关系,观察结果测量拍照.结果 颞下经岩骨入路可先根据面听神经的位置结合内听道和岩骨嵴所成的角度判断出内听道在岩骨前表面的投影.以内听道为标志,可以将岩骨分为内听道周围部分和内侧岩尖部分共两部分来磨除岩骨.结论 采用颞下经岩骨入路可根据术中实际需要合理地磨除岩骨,进一步增加对岩斜区结构的显露,具有显露充分、操作简单、安全性高的特点.

Objective To explore the anatomical structure and identify the safe resecting region in the temporal base approach of transpetrosal subdura.To explore ways to grind petrous bone easily.Method The subtemporal approach was simulated in 10 （ 20 sides ） formalin - fixed cadaveric adult heads to observe the grinding of the bone.The results of observation were photographed and measured to provide the safe range of the grinding petrous bone.Results As a symbol of the auditory canal, bone was divided into the part of around the internal auditory canal and the petrous apex.The bone around the internal auditory canal was devided into the lateral internal auditory canal and upper part.Distance of about 5 mm to the internal auditory canal could be grinded.The yard of the inside petrous apex could be grinded safly.Grinding the subdural bone could increase the vertical angle up to 15°.Conclusions The subtemporal tentorial approach can increase the view on the structure of the posterior fossa.It gives the priority exposure for the base of posterior fossa tumors.