颈内动脉外侧间隙的显微外科解剖

Microsurgical anatomy of the interspace lateral to internal carotid artery

目的 :探讨颈内动脉外侧间隙的手术解剖 .方法 :模拟 4个手术视角 ,在 14例尸体标本上作 2 8侧间隙的显微解剖 .结果 :该间隙大致呈V形 ,前岩床皱襞将其分为内、外侧两部分 .间隙的内侧边为颈内动脉和前床突 ,外侧边通常为颞叶前下面 ,含有蛛网膜和纤维小梁等结构 .视角越偏侧方 ,底边常越短 ,内、外侧边却变化不大 ,间隙下方结构均随方位改变 .结论 :对于年轻人 ,该间隙常在 0°至 10°视角下最宽大 .对于脑萎缩者 ,常在 30°至 4 5°时最宽大 .要经该间隙达到鞍后区 ,至少应取 4 5°视角 。

AIM: To study surgical anatomy of the interspace lateral to internal carotid artery. METHODS: Microsurgical anatomy of 28 interspacevs lateral to internal carotid artery was observed at 4 operational angles using 14 cadeveric heads. RESULTS: The interspace was V shaped on the whole. Anterior petroclinoid fold divided the interspace into medial part and lateral part. The medial edge of the interspace was the internal carotid artery and anterior clinoid process. The lateral edge was usually the anterior inferior surface of temporal lobe. There were some structures such as arachnoid and fibrous trabeculae in the interspace. When the operational angle along the skull base was more lateral, the base edge commonly became shorter, but the medial and lateral edges changed less, and the position of the structures below the space changed correspondingly. CONCLUSION: The interspace appears to be maximal at the angles of 0° to 10° in young cases, but at 30 °to 45° in the cases of brain atrophy. Towards the area posterior to sella turcica in operation, 45° should be adopted at least, and temporal lobe should be pulled laterally.