颞下经岩嵴入路颅骨钻孔定位的相关解剖研究  

Skull anatomy v/a subtemporal transpetrosalridge approach

作　　者：张长风[1] 陈礼刚 李定君[2] 顾应江[2] 肖洪文[2] 贺晓生[3] 

机构地区：[1]资阳市第一人民医院神经外科,641300 [2]泸州医学院附属医院神经外科,泸州646000 [3]第四军医大学西京医院神经外科,西安710000

出　　处：《中华神经医学杂志》2014年第2期138-141,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨颞骨岩部前后界和中脑前后界在体表和颅骨表面的投影，以确定在颞下经岩嵴人路骨瓣成形时，幕上颞枕部颅骨钻孔的位置。方法10例（20侧）国人汉族成人头部湿标本固定后在CT上以OM为基线对颅底行薄层扫描，并用钛钉定位标记相关解剖体表投影点。投影点钻孔（孔1位于耳屏前颧弓根部上缘的凹陷处，孔2位于顶乳缝前端上方1cm处；孔3位于星点上方lcm处），置人塑料管，测量相关数据。结果3个孔均位于幕上，对应颞叶底部。孔1在大脑表面大多数对应颞下回，在深面对应颢骨岩部前界和中脑前界：孔2位于幕上，在深面对应颞骨岩部后界和中脑后界：孔3对应小脑幕上缘和枕前切迹。结论3个孔的连线定位了小脑幕上缘的体表投影．可作为颞下经岩嵴人路开颅钻孔的定位点。Objective To establish standard sites for bur holes that maintain constant anatomical relationships with the skull base and neural structures and can serve as the basal aspect of supratentorial temporooceipital craniotomies such as subtemporal transpetrosalridge approach. Methods To determine cranial-cerebral relationships, the authors delimited 10 adult cadaveric skulls anteriorly and posteriorly the external projection of the petrous bone and the midbrain by CT and Titanium nail. Then bur holes in adult cadaveric skulls were created （kl, the first bur hole, located anterior to the auricle of the ear; k2, the second bur hole, whose base was located 1 cm above the interface of the parietomastoid and squamous sutures; k3, the third bur hole whose base was located lcm above the asterion）. Three bur holes were made on each of the skulls （20 cerebral hemispheres）. The author then introduced plastic catheters through the bur holes to evaluate pertinent cranial and neural landmarks. Results The first bur hole appeared to have a particular anatomical relationship with the anterior aspect of the petrous portion of the temporal bone and the most anterior aspect of the midbrain. The second bur hole had a particular relationship with the posterior border of the petrous portion of the temporal bone and with the posterior aspect of the midbrain. The third bur hole was mostly supratentorial and particularly related to the preoccipital notch. Conclusions The middle fossa floor is located anterior to the site of the kl, and the superior surface of the tentorium is posterior to k2. Together with k3, these bur holes can be considered standards for temporooccipital craniotomies such as subtemporal transpetrosalridge approach.

关 键 词：体表投影 颅底 颞下经岩骨嵴入路 解剖 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学]