内窥镜辅助颞下锁孔入路的应用解剖

Anatomic study of subtemporal keyhole approach

目的 :为颞下锁孔入路提供解剖学基础。方法 :2 1例福尔马林固定尸体头部标本上进行入路相关解剖结构观察和测量 ,在 9例新鲜标本上模拟内窥镜辅助颞下锁孔入路手术 ,记录入路的显露范围及可利用的操作空间 ,尝试增加显露和操作空间的方法。结果 :圆孔、卵圆孔、棘孔、三叉神经压迹、弓状隆起、岩大神经裂孔到颞下颌关节处颧弓上缘和中线的距离分别为 :(4 5 .2± 3 .3 )mm和 (2 0 .1± 2 .3 )mm、(3 2 .6± 2 .1)mm和 (2 3 .7± 1.2 )mm、(2 8.9± 1.1)mm和 (3 1.2± 3 .1)mm、(4 0 .1± 1.2 )mm和 (15 .6±2 .7)mm、(2 5 .0± 2 .7)mm和 (3 3 .8± 0 .9)mm、(2 6.7± 2 .3 )mm和 (2 9.6± 0 .8)mm ,Kawase三角各边长度 :耳蜗至岩大神经与下颌神经交点 (18.6± 1.6)mm、耳蜗至三叉神经孔 (19.6± 1.5 )mm、三叉神经孔至岩大神经与下颌神经交点 (16.2± 0 .8)mm ;Day菱形区各边长度 :三叉神经孔至岩大神经与下颌神经交点(16.2± 0 .8)mm、弓状隆起至三叉神经孔 (2 1.7± 2 .5 )mm、岩大神经与下颌神经交点至膝状神经结 (7.2± 1.3 )mm、膝状神经结至弓状隆起 (12 .5± 2 .1)mm ;颞下锁孔入路最大控制范围前至视交叉 ,后到脑干腹外侧乳头体至中下斜坡的区域。结论 :颞下锁孔入路是治疗鞍上区和岩斜区病变?

Objective: To discuss the exposure scope and working area of subtemporal keyhole approach, and offer the anatomic features of the approach to the clinical surgeons. Methods: Anatomic structures were studied and measured in 21 adult cadaver heads fixed in formalin and endoscope-assisted subtemporal keyhole approach was performed in 9 fresh cadaver heads. The marking structures and their relatives, the exposure scope, the working area were recorded and several techniques were applied to wide the working area. Results: the length from the foramen rotundum, foramen ovale, foramen spinosum, trigeminal nerve impression, arcuate eminence, greater petrosal nerve hiatus to the uperior margin of zygomatic arch at temporomandibular joint and the midline are respectively: 45.2±3.3 mm and 20.1±2.3 mm ,32.6±2.1 mm and23.7±1.2 mm, 28.9±1.1 mm and 31.2±3.1 mm, 40.1±1.2 mm and 15.6±2.7 mm ,25.0±2.7 mm and 33.8±0.9 mm ,26.7±2.3 mm and 29.6±0.8 mm; The length of the borders of the Kawase triangle are respectively: cochlea to GSPN-V3 junction 18.6±1.6 mm, cochlea to porus trigeminus 19.6±1.5 mm, porus trigeminus to GSPN-V3 junction16.2±0.8 mm; The length of the borders of the Day rhombus are respectively: porus trigeminus to GSPN-V3 junction16.2±0.8 mm, arcuate eminence to porus trigeminus 21.7±2.5 mm, GSPN-V3 junction to geniculate ganglion 7.2±1.3 mm, geniculate ganglion to arcuate eminence 12.5±2.1 mm. Through the endoscope-assisted subtemporal keyhole approach, scopes between the optic chiasma and the ventral brain stem, from the mamillary body to the middle-inferior clivus can be well managed. Conclusions: The subtemporal keyhole approach is suitable for operations in the suprasellar region and petroclival region.