改良乙状窦前经部分骨迷路入路的显微解剖  

The microsurgical anatomy of the modified presigmoid transpartial bony labyrinth approach

作　　者：罗正祥[1] 赵鹏来[1] 杨坤[1] 刘永[1] 张岩松[1] 

机构地区：[1]南京医科大学附属脑科医院,南京210029

出　　处：《中华显微外科杂志》2013年第3期261-264,共4页Chinese Journal of Microsurgery

基　　金：南京市卫生局青年启动项目基金（QYKlll26）;南京医科大学科技发展基金面上项目（NJMU091）

摘　　要：目的目的研究改良乙状窦前经部分骨迷路人路的显微解剖暴露，探讨其对岩斜区的显露及在手术处理该区域病变中的优势。方法2012年4月至10月，对15具尸头标本进行手术入路的改良研究，在传统乙状窦前人路的基础上切除部分半规管和岩尖，详细记录岩斜区重要结构的显露情况。结果该人路能够提供至岩斜区和海绵窦后部宽大的操作空间，在乙状窦前显露范围（水平方向）为（19．41±1．58）mm，在颞叶下方的显露范围（垂直方向）为（14．18±1．88）mm]，斜坡中心凹陷的最大暴露角度为（60．54±6．93）°，手术操作深度（55．87±4．34）mm°椎一基底动脉、小脑前下动脉、小脑上动脉、同侧第Ⅲ-Ⅹ对和对侧第Ⅵ对脑神经、三叉神经腔、海绵窦后部等均显露良好。结论改良乙状窦前经部分骨迷路入路能够获得岩斜区深面和海绵窦后部良好暴露，具有暴露范围大、观察角度多、保留面听神经功能、早期阻断肿瘤的血供等方面的优势。Objective To investigate the surgical techniques of the modified presigmoid trans-partial bony labyrinth approach and the advantages in exposure of the petroclival region and in treat the lesion of this area. Methods By simulate the modified presigmoid trans-partial bony labyrinth approach in 15 adult cadaveric heads with the aid of an operating microscope and record important structures in the pctroclival region. Results The petroclival region, the posterior cavernous sinus, Meckel cave, the vertebral-basilar artery, the anterior inferior cerebellar artery, the superior eerebellar artery, ipsilateral Ⅲ-Ⅹ cranial nerve here fully exposured and contralateral VI cranial nerve were fully exposure＆ The range of presigmoid exposure was （19.41 ± 1.58） mm, the exposurein of inferior temporal was （ 14. 18 ± 1.88 ） into, the maximmn exposure angle of slope center depression was （ 60. 54 ± 6. 93 ）°, the depth of operation was （ 55.87 ± 4. 34 ） mm. Conclusion The advantages of the modified presigmoid trans-partial bony labyrinth approach can earn enough exposures of deep part of petroclival region and posterior part of cavernous sinus, improved petroelival exposure, multiple axes of visualization, oreservation of hearing and facial nerve function, and early devaseularization of the tumor.

关 键 词：岩斜区 乙状窦 经骨迷路入路 显微解剖 

分 类 号：R739.4[医药卫生—肿瘤]