扩大颅中窝硬脑膜外经颞骨岩部入路至岩斜区的应用解剖

Applied anatomy of extended middle fossa extradural transpetrosal approach to petroclival region

目的 :研究颅中窝硬脑膜外经颞骨岩部入路进行岩斜区直接手术的手术方法 ,并提供相应的解剖依据。方法 :用 1 5例成人尸体头部标本模拟颅中窝硬脑膜外经颞骨岩部入路进行岩斜区及其邻近结构的显露和解剖。结果 :①岩大神经是磨除颞骨岩部十分重要的标志 ,通过它可以定位岩部颈内动脉、耳蜗和膝状神经节 ;②颅中窝硬脑膜外经颞骨岩部入路可以充分暴露从鞍背到桥延沟的岩斜区。结论 :①以岩大神经为标志磨除颞骨岩部为安全手术提供了保证 ;②此入路具有暴露好、神经血管损伤小的特点 ,特别适用于骑跨颅中、后窝的岩斜区病变。

Objective: To study the operative technique for extended middle fossa extradural transpetrosal approach to petroclival region and to provide correspondingly anatomical basis. Methods: A microsurgical study was performed in fifteen cadaveric adult head specimens. Exposure and dissection were undergone on petroclival region and its surrounding structures using an extended middle fossa extradural transpetrosal approach. Results: ① The greater superficial petrosal nerve was an important landmark in drilling petrous bone. Backing it we can find out the intrapetrous carotid artery (ICA), cochlear and geniculate ganglion (GG); ② Extended middle fossa extradural transpetrosal approach offered appropriate exposure of the petroclival region from dorsum sellae to pontomedullary sulcus. Conclusions: ① The greater superficial petrosal nerve provides guarantee that drilling petrous bone is safe; ② This surgical approach has good exposure and minimal neurovascular structures damage and is especially suitable for the lesions that extend into the middle and posterior fossa.