经岩骨后入路的应用解剖学研究

Applied anatomy of the trans-retro-petrous approach

目的从应用解剖学入手,量化和微创化研究经岩骨后入路。方法在手术显微镜下,对20侧(10具)福尔马林固定的成人头颅标本进行颅底剖面的解剖测量;对6侧(3具)头颅标本模拟经岩骨后入路,进行入路全程解剖观察。结果确定了经岩骨后入路的骨窗后下界和入路行经的重要路标;观测了面神经管和迷路结构的解剖关系;明确了安全切除岩尖区骨质的范围。依据上述观测结果,模拟、验证经岩骨后入路,并提出改进方法。结论传统经岩骨后入路对岩尖区硬膜内结构的暴露范围有限,手术风险较大。通过量化、微创化研究经岩骨后入路的硬膜外骨切除操作,改进硬脑膜和小脑幕切开方法,明显扩大对岩尖区硬膜内结构的显露,确保手术的安全性。

Objective To provide detailed anatomic information for the quantification and microinvasion in the Trans-retro-petrousapproach (TRPA).Method The axial sections of skull base were microscopically measured in20sides of10adult cadaveric heads fixed in formalin,whereas the TRPA being performed was observed in6sides of3heads.Result The posteroinferior borderline of bone opening and the key landmarks in TRPA were defined.The anatomic relations between fa-cial nerve canal and labyrinthine were measured.The limitation of petrous apex region(PAR)bone for safe resection was con-fined.Based on most of information above,the TRPA was mimiced for a purpose of verification and improvement.Con clusion The intradural stuctures in PAR are exposed limitedly through the traditional TRPA,which could be a great risk for an opera-tion in PAR.The significant improvement in the exposure of intradural portions in PAR is achieved to render a safer opera-tion via the quantification and microinvasion of extradural bone removel in TRPA,as well as the reformation in openings of dura and tentorium