颅后窝外侧入路术的应用解剖

Applied anatomy of lateral approach technique for posterior cranial fossa

目的 :为颅后窝手术入路提供避免损伤血管神经等的解剖学依据。方法 :解剖测量 16例成人头颅标本。结果 :乳突尖至茎突尖、寰椎横突外侧端和茎突尖至寰椎横突外侧端三者之间的距离分别为(3 0 .67± 6.3 8)mm ,(2 4.15± 4.46)mm和 (15 .2 0± 3 .5 0 )mm。乳突尖至面神经、颈静脉孔的外缘和颈动脉管外口的外缘、枕骨髁外侧缘中点的距离分别为 (10 .11± 3 .0 2 )mm ,(2 2 .93± 3 .5 9)mm ,(3 0 .40±3 .3 7)mm和 (3 1.43± 3 .11)mm。乳突尖至Ⅸ、Ⅹ、Ⅺ和Ⅻ对脑神经出颅处的距离分别为 (2 6.13± 5 .49)mm ,(2 4.2 7± 4.11)mm ,(2 1.17± 4.3 4)mm和 (2 4.64± 4.64 )mm。结论 :在颅后窝外侧入路的手术中 ,应重视乳突至茎突、寰椎横突外侧端和茎突至C1横突外侧端的间距 ,以及乳突至颈内静、动脉 ,Ⅸ、Ⅹ、Ⅺ和Ⅻ对脑神经的位置和距离等能有效地在手术时保护它们。

Objective: To provide anatomical basis for posterior cranial fossa operation so as to avoid damaging the vessels and nerves. Methods: Sixteen normal adult skull specimens were dissected and measured. Results: The gaps from mastoidal to the tip of styloid process and lateral border of atlas transverse process, and the gap from the apical of styloid process to lateral border of atlas transverse process were 30.67 ±6.38 mm, 24.15±4.46 mm and 15.20±3.50 mm respectively. The gaps from mastoidal to facial nerve, to lateral border of jugular foramen, to outer entrance of carotid canal and to middle point in lateral border of occipital condyle were 10.11±3.02 mm, 22.93±3.59 mm, 30.40±3.37 mm and 31.43±3.11 mm respectively. The gaps from mastoidal to the exits of Ⅸ,Ⅹ,Ⅺ and Ⅻ cranial neves from the skull were 26.13±5.49 mm, 24.27±4.11 mm, 21.17±4.34 mm and 24.34±4.64 mm respectively. We also measured the width and thickness of Ⅸ,Ⅹ,Ⅺ and Ⅻ cranial nerves at the exits from the skull. Conclusions: During the lateral approach operation for posterior cranial fossa, importance must be given to the gaps from mastoid process to styloid process, to lateral border of atlas transverse process and the gap from styloid process to lateral border of atlas transverse process and the gap from styloid process to lateral border of C 1 transverse process. At the same time, the situation and the gaps from mastioid process to internal jugular vein, to internal carotid artery, and to Ⅸ,Ⅹ,Ⅺ and Ⅻ cranial nerves must be effectively protected.