迷路后径路内镜下行脑桥小脑三角区手术的解剖学研究

Transtemporal approach to treat petroclival lesions under endoscope:clinical anatomical study

目的 :为临床上保留迷路在内镜下行桥脑小脑三角区病变手术提供解剖学资料。方法 :在 2 0例 40侧成人尸头上模拟颞骨径路保留迷路内镜手术 ,测量乙状窦内侧至总骨脚、岩上窦下缘至外半规管在岩部后骨板延长线之间距离 ,对可操作范围进行评估 ,对内镜的导入角度进行研究。并就如何避免损伤半规管、颈静脉球、面神经、乙状窦、岩上窦等结构提出看法。结果 :岩上窦下缘至内淋巴囊上缘距离为(9 .5 3± 2 .64 )mm ,乙状窦内侧至总骨脚距离为 (13 .89± 2 .3 4)mm ,至内淋巴管距离为 (10 .62± 2 .0 9)mm ;由该三条线构成的上底为 13 .89mm ,下底为 10 .62mm ,高为 9.5 3mm的梯形为内镜操作范围。乙状窦距颞骨表面距离 (以乙状窦上膝为标准 )为 (5 .2 7± 1.60 )mm ,乙状窦宽度为 (11.97± 2 .10 )mm ,上下膝长度为 (2 4.78± 4.2 1)mm ,乙状窦与外耳道后壁距离为 (13 .5 9± 3 .0 3 )mm ,岩骨后骨板至后半规管后缘、总骨脚后缘距离分别为 (4 .0 7± 1.2 6)mm和 (5 .5 8± 1.49)mm ,内镜的导入角度应力争与岩部上嵴平行 ,这样的角度最便于观察和操作 ,且不易损伤内部重要结构。我们测得的岩部上嵴与矢状线之间角度为 (63 .87± 9.3 1)°。结论

Objective: To provide anatomical information for the treatment of petroclival lesions under endoscope while the audition and balance function can be preserved. Methods: The operations were simulated in 20 adult cadaveric specimens and correlative data were measured. The angle of endoscopic surgery, the scope of the surgery were studied. Results: The distance from superior petrosal. sinus to endolymphatic sac was 9.53±2.64 mm, from sigmoid sinus to endolymphatic duct was 10.62±2.09 mm, to common crus was 13.89±2.34 mm. The distance from duramater to posterior semicircular canal and common crus were 4.07±1.26 mm and 5.58±1.49 mm respectively. The distance from temporal bone surface to sigmoid sinus was 5.27±1.60 mm. The width of sigmoid sinus was 11.97±2.10 mm. The height of sigmoid sinus was 24.78±4.21 mm.The distance between sigmoid sinus and back wall of external acoustic meatus was 13.59±3.03 mm.The angle between petrous ridge and arrow line was 63.07±9.30 degrees and it should be the angle of endoscope. Conclusions: We can get an enough scope to treat petroclival lesions as well as save the labyrinth. Anterior displacing singmoid sinus may cumber the surgery. The surgery will be helpless if the lesions lie in internal acoustic meatus.