经乳突岩骨乙状窦前入路显微解剖与临床应用

Microscopic anatomy and clinical application of the transmastoid presigmoid sinus approach

目的:为乳突岩骨乙状窦前手术入路(TPA)提供显微解剖及临床研究。方法:经10%甲醛溶液固定的汉族成人尸体头颅湿标本15具共30侧,模拟TPA操作步骤进行显微解剖研究。选择临床上适当病例应用TPA显微切除斜坡区占位性病变5例。结果:头颅解剖上以外耳道后上棘为基点,测量其至横-乙状窦转角前缘的距离为(13.78±2.72)mm,至后半规管最后部的距离为(17.82±1.22)mm,至三叉神经压迹距离为(47.33±3.11)mm,至弓状隆起距离为(12.18±1.14)mm,至内耳门后缘的距离为(31.10±1.28)mm,至岩尖的距离为(49.11±2.41)mm;以横-乙状窦转角前缘为基点,测量其至后半规管最后部距离为(14.73±2.74)mm,至三叉神经压迹距离为(59.14±2.01)mm,至弓状隆起距离为(8.25±2.67)mm,至内耳门后缘距离为(36.48±2.73)mm,至岩尖的距离为(60.03±3.66)mm;小脑被牵离岩骨面的最大距离为(13.88±1.04)mm。临床共切除斜坡占位性病变5例,其中1例患者术前有面瘫,术后面瘫加重,另4例患者手术治疗后不适症状消失,且无并发症。结论:利用颞骨岩部体表标记与内部结构之间的关系可以很好地指导手术操作;TPA是处理岩斜区病变较好的手术方式。

Objective：To provide microscopic anatomy of the transmastoid presigmoid sinus approach （TPA） in clinical research. Methods：Fifteen cadaveric specimens （30 sides ） treated with 10% formaldehyde solution were selected for microscopic anatomy studies through simulating TPA. The space-occupying lesions of petroclival area of 5 cases were reseeted through TPA. Results： The distances from the suprameatal spine of external auditory canal which was defined as a basis points away transverse sinus-Sigmoid corner （TSC） , semicircularis eanalis ,trigeminal notch ,areuate eminence ,outer edge of internal acoustic pore and petrous apex were 13.78 ＋ 2.72mm,（17.82 ± 1.22）mm,（47.33 ±3.11）mm,（12.18 ±1.14） mm, （31.10 ＋_ 1.28） mm and（49.11 ± 2.41） mm,respectively. The distances from the leading edge of TSC which was defined as a basis points away semicircularis eanalis, trigeminal notch, arcuate eminence,outer edge of internal acoustic porise, petrous apex and the longest distance the cerebellum were （14. 73 ± 2. 74 ）mm, （59.14 ± 2.01 ） mm, （8.25 ± 2.67 ） ram, （ 36.48 ± 2.73 ） mm, （60.03 ± 3.66 ） mm and （ 13.88 ±1.04） mm, respectively. Five cases with space-occupying lesions of petroelival area were resected, 1 case with facial paralysis aggravated and preoperative symptoms of 4 cases disappeared and no complications. Conclusions：The relation of the surface markers of temporal bone rock and internal structure can guide surgery. TPA is good operation way in processing the petroclival area lesions.