乙状窦后经内听道上入路显微外科解剖学研究  

Study of the microsurgical anatomy of retrosigmoidal suprameatal approach

作　　者：李爱民[1] 殷善开[2] 陈覃[1] 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,江苏连云港222002 [2]上海交通大学上海市六医院耳鼻咽喉科,上海200233

出　　处：《中国耳鼻咽喉颅底外科杂志》2007年第6期401-406,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的研究乙状窦后经内听道上入路(RSSMA)的显微外科解剖。方法成人颅骨标本10例,头颅标本18例。在改良乙状窦后入路开颅的基础上,磨除内听道上结节和岩尖,采用实体和CT相结合的方法测量内听道上结节、岩尖的切除范围;记录内听道上结节、岩尖切除前后显露中颅窝、上斜坡的面积和三叉神经的范围;观察内听道上区的动脉、静脉、神经、硬膜等解剖结构。结果内听道上结节左右、前后方向骨性组织可全部切除,将内听道的上壁轮廓化可切除其上下径。岩尖的前后、左右、上下方向骨性组织均不能完全切除。中颅窝扩大显露范围为(144.6±13.9)mm2,上斜坡扩大显露(90.3±16.7)mm2。小脑前下动脉、后下动脉、岩上静脉、岩上窦;前庭耳蜗神经、三叉神经、外展神经均得以认定。结论RSSMA可以将乙状窦后入路的手术野扩大显露到中颅窝的中线侧和上斜坡的侧方,并可显露Meckel's腔内的三叉神经。岩骨骨迷路限制中颅窝的显露。RSSMA下的重要解剖结构有三叉神经、面听神经、小脑上动脉、小脑前下动脉、弓下动脉、岩静脉、岩上窦等,术中要注意保护。RSSMA是处理主体在后颅窝,同时侵犯中颅窝病变的安全、有效入路。Objective To study the microsurgical anatomy of the retrosigmoidal suprameatal approach（RSSMA）.Methods The suprameatal terbucle（SMT） and the petrosal apex（PA） were drilled via modified retrosigmoidal approach in 10 human crania and 18 head cadavers.The lengths of the ST and PA in three dimensions before and after the resection were measured with CT and manual measurements.The exposed field of the middle fossa and superior clivus and the length of the exposed trigeminal nerve were also measured. The microstructure of SA and PA and their related arteries,veins,cranial nerves,and dura mater were observed.Results The bony middle-lateral,anterior-posterior part of the SMT could be wholly resected.And the upper part of the internal auditory canal could be skeletonized.The PA was partially resected.The middle fossa and superior clivus could be exposed to the size of （144.6±13.9） mm2 and（90.3±16.7） mm2 respectively.The inferior anterior cerebellum artery,the inferior posterior cerebellum artery,the petrosal vein,the superior petrosal sinus,the vestibular nerve,the cochlea nerve,the trigeminal nerve,and the abducens nerve were determined.Conclusion ① The median part of the middle fossa,the lateral part of the superior clivus,and the trigeminal nerve in the Meckel＇s cave could be exposed by RSSMA.② The important anatomic structures related to RSSMA that should be protected were the trigeminal nerve,facial nerve,cochlear nerve,superior cerebellum artery,inferior anterior cerebellum artery,subarching artery,the petrosal vein,and superior petrosal sinus.The field exposure of the middle fossa via RSSMA is still limited by the bony labyrinth.③ The RSSMA is a safe and effective approach dealing with the lesions predominantly localized in the posterior fossa and invaded the middle fossa..

关 键 词：乙状窦后经内听道上入路 显微外科学 解剖学 

分 类 号：R651[医药卫生—外科学]