两种联合入路处理颈静脉孔区沟通性肿瘤的应用解剖比较

The applied anatomical comparison of two combined approaches in treatment of communicating tumors in the jugular foramen region

目的通过比较远外侧髁旁联合部分经髁入路与迷路下联合枕下乙状窦后入路,为颈静脉孔区沟通性肿瘤的临床应用提供解剖学依据。方法用16具成人尸头镜下模拟两种联合入路,比较两种联合入路对颈静脉孔区的暴露范围及相关解剖学标志,同时观察寰椎横突磨除后对颈静脉孔区颅外段的暴露情况。结果两种联合入路均可显露颈静脉孔区颅内段及有限的颅外段,但远外侧髁旁联合部分经髁入路有利于暴露颈静脉孔后内侧区域,而迷路下联合枕下乙状窦后入路更利于暴露颈静脉孔后外侧区域。枕髁和颈静脉突为前者的解剖标志,茎乳孔和颈静脉突为后者的解剖标志。寰椎横突的切除可增加颈静脉孔区颅外段茎突后间隙的显露。结论远外侧髁旁联合部分经髁入路结合寰椎横突的磨除,适宜处理肿瘤主体偏于孔内侧的颈静脉孔区沟通性肿瘤,而迷路下联合枕下乙状窦后入路结合寰椎横突的磨除,更适宜处理肿瘤主体偏于颈静脉孔外侧的沟通性肿瘤。

Objective To provide anatomical basis for the clinical application of communicating tumors in the jugular foramen region through comparing the combined far-lateral paracondylar-partial transcondylar approach with the combined infralabyrinthine-suboccipital retrosigmoid approach. Methods The exposed areas of the jugular foramen region and the corresponding anatomic marks were compared by simulating these two kinds of combined approaches under microscope in 16 cadaveric adult heads; Meanwhile, the exposed status of the extracranial segment of jugular foramen region after removal of the atlas transverse process was observed. Results These two kinds of combined approaches can reveal the intracranial segment and limited extracranial segment of the jugular foramen region. The combined far-lateral paracondylar-partial transcondylar approach is superior to reveal the posteromedial area of jugular foramen,while the combined infralabyrinthine-suboccipital retrosigmoid approach is superior to reveal the posterolateral area of jugular foramen. The occipital condyle and jugular process are anatomical landmarks of the former. The stylomastoid foramen and jugular process are anatomical landmarks of the latter. Atlas transverse process resection can extend the exposure of extracranial segment of the jugular foramen region（retrostyloid parapharyngeal space）. Conclusions With the aid of atlas transverse process resection, the combined far-lateral paracondylar-partial transcondylar approach is suitable for management of communicating tumors in the jugular foramen region whose major part was medial to the foramen, while the combined infralabyrinthine-suboccipital retrosigmoid approach is more suitable for management of communicating tumors in the jugular foramen region whose major part was lateral to the foramen.