改良经颈静脉孔入路的显微解剖研究

Microsurgical anatomy of the modified transjugular approach

目的 研究一期切除颅内外沟通型颈静脉孔 (JF)肿瘤的手术入路。方法 成人头颈标本 1 0具 ,镜下解剖经颈静脉孔入路 ,研究其扩大显露范围。结果 切除枕骨颈突、从后方显露JF ,然后切除乳突及迷路下岩骨 ,轮廓化面神经垂直段 ,扩大JF外侧显露。游离椎动脉C2 ～C1 段和水平段 ,切除C1 横突 ,扩大颈部显露。鼓乳切迹、二腹肌后腹与面神经关系密切。结论 改良经颈静脉孔入路可从后、外、下三个方向充分显露JF。鼓乳切迹。

Objective To investigate both intracranial and extracranial components surgical approach to resect the jugular foramen (JF) lesions in single stage.Methods With the aid of the magnification(×3 40), the microsurgical anatomy and extended exposure of the transjugular approach were studied in 10 cadaveric head neck specimens of adults.Results The exposure of the transjugular approach was directed through the jugular process of occipital bone to posterior surface of jugular bulk (JB). After removal of the mastoid process and the petrous bone under the labyrinth, the vertical segment of facial nerve was skeletoned. The exposure was extended lateral to JF.The transverse process of C 1 was removed and the segment of the VA between the transverse foramen of C 2 and its entrance of the dura was seperated, the cervical exposure was extended. The tympanomastoid notch and the posterior belly of digastric were closely related to facial nerve. Conclusions The modified transjugular approach can provide sufficient exposure for JF. The tympanomastoid notch and the posterior belly of digastric are useful anatomic landmarks to identify facial nerve.