扩大乙状窦后经内耳孔上入路显微外科解剖学研究  

Study on the microsurgery of the expanding retrosigmoid suprameatal approach

作　　者：李爱民[1] 鲍耀东[2] 陈覃[1] 于春江[3] 朱凤清[2] 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,江苏连云港222002 [2]苏州大学第一附属医院神经外科,江苏苏州215006 [3]北京三博脑科医院神经外科,北京100063

出　　处：《中华神经外科疾病研究杂志》2007年第6期542-544,共3页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的利用半规管切除技术,对乙状窦后经内耳孔上入路(RSA)进行改良,形成扩大乙状窦后经内耳孔上入路(ERSA),研究ERSA能否改善对中颅窝、上斜坡、三叉神经的显露。材料成人颅骨标本10例,福尔马林固定尸头标本15例,新鲜头颅标本3例。方法先行乙状窦后经内耳孔上入路,磨除内耳孔上结节、岩尖,测量三叉神经、中颅窝、上斜坡的显露范围。再行扩大乙状窦后经内耳孔上入路,向侧方将岩骨上方的骨性结构切除,显露并阻塞上、后半规管和总脚,然后切除上、后半规管,再测量三叉神经、中颅窝、上斜坡的显露范围。结果中颅窝的显露范围:RSA为(144±34)mm2,ERSA为(487.2±37.2)mm2。上斜坡显露的范围:RSA为(90.3±16.7)mm2,ERSA为(93.4±15.1)mm2。三叉神经的显露范围:RSA显露Meckel腔内的三叉神经,ERSA扩大到半月神经节及其分叉。三叉神经的显露长度:RSA为(9.1±0.7)mm,ERSA为(13.1±0.7)mm。结论和RSA相比,ERSA可进一步扩大显露中颅窝,可扩大显露三叉神经到Meckel腔内的半月神经节,但上斜坡显露范围扩大不明显。To study the effectiveness and practicability of expanding retrosigmoid suprameatal approach and its mieroanatomy. Methods A total of 10 human craniums, 15 formalin-fixed cadavers and 3 fresh cadavers was used in the study with high speed drills, Sony S-75 cyber shot and Lecia M500-N and Opton operation microscope. On the base of the retrosigmoid suprameatal approach （RSA）, the petrosal bone was removed to the common crus, superior and posterior semicireulars. The exposed field of the middle fossa, superior clivus and the exposed trigeminal nerve were measured. Then the superior and posterior semicircular were blocked and removed, and the common crus were blocked. So the expanding retrosigmoid suprameatal approach （ERSA） was performed. The exposed field of the middle fossa , superior clivus and the exposed trigeminal nerve were measured once more. Results The exposure field of the middle fossa was （487. 2 ± 37. 2） mm^2 by ERSA and （ 144± 34） mm^2 by RSA; the exposure field of superior chvus was （93.4 ± 15. 1 ） mm^2 by ERSA and （90. 3 ± 16. 7） mm^2 by RSA. The part of the trigeminal nerve in the Meckel＇s cave was exposed by RSA; the trigeminal ganglion and its branch could be exposed by ERSA. The exposed length of trigeminal nerve was （13.1 ±0.7）mm by ERSA n-an and （9. 1 ±0.7）mm by RSA. Conclusion Compared with RSA, the middle fossa can be exposed much larger. The trigeminal nerve can be exposed to the trigeminal ganglion. The exposure field of superior chvus has no difference between the two approaches.

关 键 词：显微外科 解剖学 乙状窦后入路 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]