颞下锁孔入路的显微解剖学特点与临床应用研究

Subtemporal keyhole approach microsurgery anatomy study and clinical application

目的:研究颞下锁孔入路的显微解剖学,为临床颞下锁孔手术入路提供解剖依据与支持。方法:对6例国人成人尸头模拟颞下锁孔入路手术进行显微解剖,对各重要结构及间隙之间的距离进行测量,观察显露范围和解剖关系。结果:颧弓至小脑幕缘、脑干和前床突的最短距离分别为(42.3±4.7)mm、(42.8±2.5)mm和(59.8±6.1)mm。颞骨岩部扩大磨除前后的显露面积有显著差异(P<0.05)。颞下锁孔入路可以清楚的显露海绵窦外侧壁结构、鞍侧区、颈内动脉、后交通动脉、脉络膜前动脉和垂体柄,磨除颞骨岩尖部可显著增加岩斜区结构显露。结论:颞下锁孔入路对于海绵窦外侧壁,岩斜区及鞍侧区手术具有良好显露效果,入路直接,损伤小。

Objective To study the microscopic anatomy of the path of frontotemporal-infratemporal keyhole and to provide anatomical basis and support for clinical frontotemporal-infratemporal keyhole surgical approach.Methods Microscopic anatomy of operation path of frontotemporal-infratemporal keyhole of 6 cases of Chinese adults cadaveric heads was performed,the distance between each important structure and clearance was measured and observed,and the scope and anatomy were revealed.Results The shortest distance of zygoma to the tentorium,the brainstem and the anterior clinoid process respectively were 42.3 ±4.7 mm and 42.8 ±2.5 mm and 59.8±6.1 mm.The area before and after drilling petrous bone has significant difference(P< 0.05).The frontotemporal-infratemporal keyhole approach can clearly show the lateral structures of the cavernous sinus,sellar side region,internal carotid,posterior communicating artery,Anterior choroidal artery and Pituitary stalk,drilling petrous bone can significantly increase the petroclival area structure revealed.Conclusion The frontotemporal-infratemporal kehole approach possesses ideal exposure for the lateral structures of the cavernous sinus,petroclival area,and sellar side region;the operation was directly into the way with little injury.