经口入路至颈静脉孔区的显微外科解剖

Microsurgical anatomy of transoral approach to jugular foramen region

目的:为经口入路至颈静脉孔区处理颈静脉孔区病变提供解剖学依据。方法:在显微镜下对经彩色乳胶灌注成人尸头湿标本的颈静脉孔区经口入路进行解剖,观察路径中组织结构的暴露情况和走行关系,定位相关解剖标志,记录测量数据。结果:尸头标本的颈静脉孔区颅外部分均显露良好,可暴露自颈动脉嵴内侧至枕骨髁后外侧缘和中线至茎突根部区域,磨除颈静脉孔前内侧骨质后,可观察到岩下窦、Ⅸ～Ⅺ神经在孔内走行和毗邻关系。测量相关参数,枕髁前缘距舌下神经管外口前缘(12.47±1.49)mm;舌下神经管外口上缘距颈动脉嵴内侧(9.90±1.40)mm等。结论:经口入路可较好的暴露颈静脉孔区前内侧,以枕髁和颈动脉嵴为解剖标志,有助于避免此入路处理颈静脉孔区病变时对重要血管和神经的损伤。

Objective:To provide anatomical basis for the treatment of jugular foramen lesions by microsurgical anatomy through the transoral approach to the jugular foramen.Methods:Fifteen(30 sides)adult cadaveric head specimens perfused with colored latex were used to investigate the microsurgical anatomy of the transoral approach to the jugular foramen with the help of surgical microscope,so as to observe the structure in this approach,locate the anatomic markers and measure the relevant data.Results:The extracranial part of jugular foramen was well exposed in the fifteen cadaver heads,and medial anterior lesions in jugular foramen could be exposed from carotid ridge to lateral border of occipital condyle and centerline to the styloid process.After removing the anteromedial bone of the jugular foramen,the inferior petrosal sinus,Ⅸ-Ⅺnerve walking relationship in the jugular foramen could be observed.The distance was(12.47+1.49)mm from anterior edge of the occipital condyle to the anterior edge of the hypoglossal canal external opening;the distance was(9.90+1.40)mm from superior edge of the hypoglossal canal external opening to the carotid ridge.Conclusion:The anterior medial area of jugular foramen could be well exposed through the transoral approach,and the occipital condyle and carotid ridge can be used as anatomic markers,which can protect the vital nerves and vascular structures from injury by this approach.