内镜下经口入路至颈静脉孔区处理沟通型肿瘤的临床应用解剖

Applied anatomy of the endoscopic transoral approach in treatment of the jugular foramen region communicating tumors

目的研究内镜下经口入路至颈静脉孔区解剖,以期为临床上切除该区域的沟通型肿瘤提供解剖学依据。方法在内镜下对15具尸头模拟经口入路,观察颈静脉孔区颅内外的暴露情况,定位解剖标志并记录相关参数。结果内镜下经口入路可很好显露颈静脉孔区颅外段,尤其是其前内侧区域,在磨除舌下神经管外口至中线骨质后可获得颅内脑干腹侧中线区域的最佳暴露。枕髁、髁上槽、颈动脉嵴为重要的解剖标志。其中枕髁前缘距舌下神经管外口下缘（14.51±2.30）mm,枕髁前缘距颈动脉嵴（24.11±2.19）mm,枕髁前缘距颈静脉结节上端（21.26±2.26）mm。结论该入路有助于处理肿瘤主体偏于颈静脉孔内侧的沟通型肿瘤。

Objective Study on anatomy of endoscopic transoral approach to jugular foramen, in order to the application of this approach to remove the communicating tumor in jugular foramen region.Methods With the aid of endoscope,15 cadaveric head specimens were used to simulate transoral approach to jugular foramen. The extracranial and intracranial structures of jugular foramen were observed, the anatomic landmarkers were located and the relevant data measured. Results Transoral approach could reveal extracranial region of jugular foramen well, especially the anterior medial region. The best exposure to the midline region of the brain stem was obtained after removing the bone from the external opening of the hypoglossal canal to the midline of the clivus. The occipital condyle, supracondylar groove and carotid ridge were important anatomical landmarks in this approach. The distance was（14.51±2.30） mm from the anterior edge of the occipital condyle to inferior edge of the external opening of the hypoglossal canal. The distance was（24.11±2.19） mm from anterior edge of the occipital condyle to carotid ridge. The distance was（21.26±2.26） mm from anterior edge of the occipital condyle to the upper edge of the jugular tubercle. Conclusion This approach is helpful in dealing with the principal part of tumors in the medial region of the jugular foramen.