岩斜区侧方手术入路相关血管神经显微外科解剖

Microanatomy and application of nerves and blood vessels concerning to lateral operation approach in petroclival region

目的 :为岩斜区侧方手术入路提供显微外科解剖学基础。方法 :15例头颅湿标本 ,模拟手术入路解剖观测相关重要血管神经走行长度及相互毗邻关系。观察了Labbe’s静脉 ,岩静脉 ,小脑前下及后下动脉走行及与神经的关系。结果 :测得三叉神经出颅部到正中矢状面距离、角度及颅内段长度分别为(13 .1± 2 .1)mm (10 .2～ 15 .3mm ) ,19.3°± 8.1°(14 .5°～ 2 5 .0°) ,(14 .0± 1.9)mm (11.6～ 18.2mm ) ;展神经分别为 (10 .0± 1.7)mm (8.9～ 11.9mm ) ,2 5 .3°± 12 .3°(2 1.0°～ 2 7.6°) ,(17.1± 3 .5 )mm (14 .0～ 2 1.0mm) ;面和前庭蜗神经分别为 (2 3 .8± 2 .9)mm (2 .1～ 3 .2mm ) ,70 .3°± 5 .6°(65 .0°～ 78.3°) ,(14 .8±2 .3 )mm (11.2～ 2 0 .1mm) ;舌咽神经分别为 (2 3 .1± 3 .1)mm (19.8～ 3 4.1mm ) ,67.5°± 7.6°(5 9.6°～70 .4°) ,(14 .9± 1.9)mm (13 .0～ 16.7mm )。结论 :①颞下、乙状窦前及乙状窦后入路适用于中、上岩斜区病变 ;枕下远外侧入路适用于下岩斜区病变。②本文岩斜区重要神经血管形态及相互关系测量数据 ,可提高该区相关手术的安全度和成功率。

Objective: To provide anatomic data for lateral operation approach in petroclival region. Methods: The length, course and relationships of nerves and blood vessels of petroclival region were studied on fifteen wet cadaver head specimens. Results: The distance from cranial outlet to median line, the angle to median line and the length of intracranial segment of trigeminal nerve were 13.1±2.1 mm(10.2～15.3 mm),19.3°±8.1°(14.5°～25.0°) ,14.0±1.9 mm(11.6～18.2 mm).The above mentioned values of facial and acoustic nerve were 3.8±2.9 mm(2.1～3.2 mm),70.3°±5.6°(65.0～78.3)°,14.8±2.3 mm(11.2～20.1 mm), glossopherygeal nerve 23.1±3.1 mm(19.8～34.1 mm),67.5°±7.6°(59.6～70.4) °,14.9±1.9 mm(13.0～16.7 mm), and abducent nerve 10.0±1.7 mm(8.9～11.9 mm),25.3°±12.3° (21.0 ～27.6) °,17.1±3.5 mm(14.0～21.0 mm) respectively. The course of Labbe’s vein, petrosal vein, PICA and AICA were observed and the relationship between vessel and nerves were analysed too. Conclusion: ①Presigmoid approach, inferior temple approach and posigmoid approach are beneficial for disease in upper and middle petroclival region ,while extreme lateral suboccipiccal approdch are adapted to the disease in inferior petroclival. ②Understanding the shape and location relationship between vessels and nerves in petroclival is favorable for operation.