后组颅神经的颅底内镜手术解剖

Endoscopic Anatomy Study of Lower Cranial Nerves

目的：观察迷路后和乙状窦后径路后组颅神经内镜手术的相关解剖结构，为后组颅神经内镜手术提供解剖资料。方法：在8例16侧成人尸头上模拟实施迷路后和乙状窦后径路后组颅神经内镜手术，观察手术径路上各结构对手术的影响以及第9～12颅神经之间的解剖关系；去除顶骨、大脑以及部分小脑组织，暴露颈静脉孔、内耳门及其周围结构，测量颈静脉孔上缘距内耳门下缘垂直距离。结果：8例16侧标本均顺利完成迷路后径路模拟内镜手术；2例4侧在不损伤小脑情况下顺利完成乙状窦后径路模拟手术，小脑为内镜导入的主要障碍。镜下观舌咽和迷走神经之间间距相对较大，迷走神经和副神经发生部相距很近；舌下神经位于上述颅神经前、内、下方，形成5～8束较细神经纤维平行分布。颈静脉孔上缘距内耳门下缘垂直距离为（8．26±1．05）mm。结论：迷路后径路为后组颅神经内镜手术较理想径路，而单纯依靠乙状窦后“锁孔”入路实施内镜手术相当困难；内耳门是手术中可靠的定位标志。

Objective：To provide anatomic data of lower cranial nerves to avoid damnification in the endoscopic surgery.Methods：To perform the postlabyrinthine and postsigmoid endoscopic surgery on 8 fomalin-fixed adult cadaver specimens , the lower cranial nerves was observed by endoscope , and the different approa-ches were compared at the same time .To excise the calvarium and cereburm , the nerves were exposed and ob-served, the distance from internal accoustic pore to glossopharyngeal was measured .Results：All postlabyrin-thine endoscopic surgeries were performed successfully;only 4 postsigmoid endoscopic surgeries were performed as well.The distance from internal accoustic pore to glossopharyngeal was （8.26 ±1.05）mm.Conclusions：The lower cranial nerves endoscopic surgery can be performed successfully by postlabyrinthine , the“lockhole” tech-nology by postsigmoid is not the appropriate lower cranial nerves endoscopic surgery .The internal acoustic porus is a fixed structure of the cerebellopontine angle;it is a perfect landmark to the surgery .