乙状窦后经内耳道上入路显露范围的量化研究  

Quantitative study on enlarging exposure via retrosigmoid suprameatal approach

作　　者：李爱民[1] 殷善开[2] 陈覃[1] 鲍耀东[3] 关建[2] 刘希光[1] 夏咏本[1] 

机构地区：[1]徐州医学院附属连云港医院神经外科中心,江苏徐州222002 [2]上海交通大学上海市第六医院耳鼻喉科,上海200233 [3]苏州大学附属第一医院神经外科,江苏苏州215006

出　　处：《中国微侵袭神经外科杂志》2007年第12期545-547,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的量化研究在乙状窦后入路基础上磨除内耳道上区骨性结构前后显露颅中窝、上斜坡的变化情况。方法在8～12倍手术显微镜下对成人颅骨标本10例、10%甲醛溶液固定头颅标本18例进行研究。经乙状窦后入路开颅,磨除内耳道上结节和部分岩尖,采用实体和CT相结合的方法测量内耳道上结节、岩尖的切除范围,记录内耳道上结节、岩尖切除前后颅中窝、上斜坡的显露面积和三叉神经的显露范围。结果内耳道上结节左右方向、前后方向骨性组织可全部切除,将内听道的上壁轮廓化切除其上下径;岩尖的前后、左右方向、上下方向骨性组织均不能完全切除。颅中窝扩大显露范围为(144.6±13.9)mm2,上斜坡扩大显露(90.3±16.7)mm2。结论采用乙状窦后经内耳道上入路,可将乙状窦后入路的手术野扩大到颅中窝的中线侧和上斜坡侧方,并可显露Meckel腔内的三叉神经。Objective To study the quantitative changes in the exposure of the middle fossa and the superior clivus via a retrosigmoid suprameatal approach. Methods Ten dry skull samples and 18 cadaver heads fixed by 10% formaldehyde solution were studied under operation microscope with 8 to 12× magniffication. Based on the retrosigrnoid approach, the suprameatal tubercle and partial petrosal apex were drilled. The CT and the manual measurements were used for determining the extension of the suprameatal tubercle and petrosal apex in three dimensions before and after the resection of them. The exposed field of the middle fossa and superior clivus and the length of the exposed trigeminal nerve were also measured. Results The bony tissue in the middle-lateral and anterior-posterior direction of the suprameatal tubercle could be wholly resected. And in the superior- inferior direction, auditory canal could be skeletonized. The petrosal apex could be only partially resected. The enlarged exposed area of the middle fossa and superior clivus should be （144.6 ± 13.9） mm^2 and （90.3 ±16.7） mm^2 respectively. Conclusion The median part of the middle fossa, the lateral part of the superior clivus and the lrigeminal nerve in the Meckel cave could be exposed via a retrosigmoid suprameatal approach.

关 键 词：乙状窦后入路 内耳道上 尸体解剖 

分 类 号：R322-33[医药卫生—人体解剖和组织胚胎学]