颞下经小脑幕手术入路的应用解剖学研究

Applied anatomy of subtemporal transtentorial approach

目的:测量颞骨岩部重要骨性结构,探讨小脑幕裂孔侧血管、神经位置的关系,为颞下经小脑幕入路提供解剖学基础。方法:在15例(30侧)颅骨标本上,以弓状隆起最高点为基点测量其与破裂孔外缘、面神经管裂孔、内耳孔后缘的距离。在10例(20侧)成人尸体头部行颞下经小脑幕入路,观测小脑幕裂孔侧方区域小脑上动脉、大脑后动脉、动眼神经、滑车神经、三叉神经以及小脑幕间的关系。结果:弓状隆起最高点距破裂孔外缘(34.98±1.67)mm,距面神经管裂孔(14.67±1.74)mm,距内耳孔后缘(15.31±1.78)mm;Labbe静脉入横窦处距STP(横窦、乙状窦、岩上窦交界)(24.60±5.82)mm;滑车神经入小脑幕游离缘处距后床突后外方(15.50±3.85)mm。结论:测量弓状隆起最高点与破裂孔外缘、面神经管裂孔、内耳孔后缘的距离及观测小脑幕裂孔侧区域小脑上动脉、大脑后动脉、动眼神经、滑车神经、三叉神经的走行有利于提高颞下经小脑幕手术入路的安全性和成功率。

Objective： To measure the bony structure of petrous bone and explore relationship between the nerve and blood vessel around the tentorium cerebelli hiatus to provide the anatomical basis in subtemporal transtentorial approach. Methods： The highest point of the arcuate eminence was set as the base-point,the distance of the outer edge of foramen lacerum,hiatus canalis facialis and posterior border of the internal auditory foramen from the base-point in 15 cases（ 30 sides） were measured. The superior cerebellar artery,posterior cerebral artery,oculomotor nerve,trochlear nerve,trigeminal nerve and tentorium of cerebellum,and their relationship with tentorium cerebelli were observed in 10（ 20 sides） heads with subtemporal transtentorial approach. Results： The distances of the highest point of arcuate eminence from the outer edge of Foramen lacerum,hiatus canalis facialis and posterior border of the internal auditory foramen were（ 34. 98 ± 1. 67） mm,（ 14. 67 ± 1. 74） mm and（ 15. 31 ± 1. 78） mm,respectively. The distance between the terminations of the labbe vein and STP（ including transverse sinus,sigmoid sinus and rock junction of the sinus） was（ 24. 60 ± 5. 82） mm,and the distance between the trochlear nerve into the free margin of the tentorium and posterior clinoid were（ 15. 50 ± 3. 85） mm,respectively.Conclusions： Measuring the distances of the highest point of arcuate eminence from outer edge of foramen lacerum,hiatus canalis facialis and posterior border of the internal auditory foramen and detecting the tracks of superior cerebellar artery,posterior cerebral artery,oculomotor nerve,trochlear nerve and trigeminal nerve around the tentorium of cerebellum can improve the safety and successful rate in subtemporal transtentorial approach.