岩骨后壁的显微外科解剖对听神经瘤手术中骨迷路保护的意义

Microsurgical anatomy of the posterior pyramidal walland its application to the preservation of thelabyrinth in acoustic neuroma surgery

目的观察岩骨后壁表面标志与骨迷路的空间位置关系,为外科手术听力保护提供解剖学基础。方法20例甲醛固定的成人头颅标本,在手术显微镜下磨除岩骨后壁,充分暴露骨迷路,游标卡尺进行测量。结果乙状窦前缘与岩嵴相交点前1.24cm、岩嵴下0.34cm,岩骨后壁0.2 cm以内磨除骨质,可不破坏骨迷路结构。结论掌握岩骨后壁表面标志与岩骨内部结构的空间位置关系,是术中定位岩骨内部结构、充分磨除岩骨、扩大手术视野及减少手术并发症的关键。

Objective To study the space relationship between the landmarks of the posterior pyramidal wall and labyrinth for the hearing preservation in the surgery. Method 20 adult cadaver heads (40 sides) were examined. Results Drilling of the posterior pyramidal wall may proceed rather safely at a minimum depth of 2.0 mm in an area 1.24 cm anterior and 0.34 cm inferior to the petrosigmoid intersection and petrous ridge, respectively. Conclusion A good knoledge of those space relationships is vital to localize labyrinth expose the surgical field and reduce complications.