改良的乙状窦后-内耳道上入路显微应用解剖学研究

The microscopic anatomical study with the improved sinus sigmoideus-into the internal acoustic meatus road

目的:探讨将现代影像技术与神经导航仪相结合用于改良的乙状窦后—内耳道上入路来进行量化研究内耳道上结节和岩尖的扩大磨除的范围以及其安全性、有效性和实用性。材料:10%甲醛固定好的成人尸头标本15例(双侧共计30组数据)、64排螺旋CT(0.625mm层厚)、Mimics V10.0软件、神经导航仪等。方法:在神经导航仪的精确引导下模拟该手术入路,并进行逐层显微解剖定位,从后向前对内耳道上结节和岩尖的骨质进行安全磨除,以提高骨质磨除的安全性,并采用CT测量的方法来观察和测量内耳道上结节和岩尖的磨除范围以及三叉神经等结构的显露范围;并借助Mimics V10.0软件来三维重建内耳及颞骨,以此来估算岩骨骨质磨除相对比较安全的范围。结果:通过本次实验研究,在改良的RSSMA中,内耳道上结节前—后、中线一侧方的骨质可以全部磨除;岩尖的上—下(可磨除8.22mm骨质)、前—后:中线一侧方的骨质可以部分磨除;其中三叉神经在磨除后可增加显露9.26mm;内耳道前后壁夹角可扩大33.06°的手术视野;可显露上斜坡的范围约93.08mm2,中颅窝约148.76mm2。结论:在现代医学影像技术与神经导航仪相结合的条件下进行改良的RSSMA较传统入路更简便、安全、实用、微创,改良的RSSMA是岩斜区肿瘤手术治疗的较佳选择。

Objective： To explore the way by which the modem imaging technology combined with neuronavigation device to use the improved sinus signaoideus - into the internal acoustic meatus road （ Retrosigrnoidal suprameatal approach, RSSMA） to quantify the ampliative mill range of the internal acoustic meatus and the apex partis petrosae as well as its safety, effectiveness and practicality. Materials： 15 cases of adult dead heads （beth bilateral have 30 sets of data） which were primed by 10% formalin, 64 - slice spiral CT （0.625mm thick）, Mimics V10.0 software, neuronavigation systems and so on. Methods： Using the accurate neunmavigatinn systems to simulate the surgical approach and dissect micmscopiely layer by layer, mill（from back to front） the internal acoustic meatus and the apex partis petresae securely, in order to improve security of the milling, and using CT measurements to observe and measure the grinding scope of the internal acoustic meatus and the apex partis petrosae and then measure the exposure range of trigeminal nerve; Using Mimics V10.0 software to reconstruct the three- dimensional inner ear and temporal bone, and then estimate the relatively safe grinding range of the petrous bene. Results： Through this experimental study by the improved RSSMA, the front- back, middle- side of the internal acoustic meatus can all be worn out completely; the up - down （8..22mm bone can be worn out ）, front - back, middle - side of the petrous bone can be partially worn out; the trigeminal nerve can be exposed ampliatively 9.26mm; the surgical field of the anterior and posterior wall of the auditory canal can expand 33.06° angle; the superior clivus can be exposed 93.08 mm2,the middle fessa is about 148.76mm2. Conclusion： The improved RSSMA approach which combined with neuronavigation device and modem medical imaging technology is much more simple, practical, minimally invasive and safer than the traditional, and it is a better option for the petreclival tumor surgery.