经岩乙状窦前入路最小化乳突切除的解剖学定量分析  

Quantitative anatomical analysis of minimized mastoidectomy via the transpetrosal-presigmoid approach

作　　者：袁孝宽 田震 祝应平 宋雅洁 沈亮 刘芳[1] Yuan Xiaokuan;Tian Zhen;Zhu Yingping;Song Yajie;Sheng Liang;Liu Fang(Department of Neurosurgery,the Third Affiliated Hospital of Nanjing Medical University(the Second People′s Hospital of Changzhou),Changzhou 213000,China)

机构地区：[1]南京医科大学第三附属医院(常州市第二人民医院)神经外科,常州213000

出　　处：《中华神经外科杂志》2025年第2期181-186,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82472668);常州市卫健委科技项目前沿技术(0Y202305);南京医科大学常州医学中心重点项目(CMCM202304);南京医科大学常州医学中心科研创新一般项目(CMCB202202);常州市社会发展项目(CE20225058)。

摘　　要：目的探讨在不轮廓化半规管和面神经管的前提下,确定经岩乙状窦前入路手术的最小乳突骨质切除范围,以及轮廓化与否对手术显露面积和手术自由度的影响。方法收集行头颅CT血管成像(CTA)检查的无颅骨畸形的成年患者,将头颅CTA数据导入3D Slicer软件行三维重建。采用3D Slicer软件分别标记100例三维重建骨质模型中的亨勒棘、上半规管顶点、外侧半规管中点、后半规管前点、后半规管后点、乳突尖,并测量连接亨勒棘与乳突尖、半规管各关键点之间的线段在矢状面的投影距离,并确定半规管和面神经的最小骨质保护区域。采集尸头标本5具(10侧),模拟常规经岩乙状窦前入路手术,行乳突骨质切除,分别在未轮廓化半规管(保留保护区域)和轮廓化半规管(磨除保护区域)后,测量各关键点间线段在矢状面的投影距离、乙状窦前显露面积和颞下显露面积,以及手术自由度。结果所有尸头手术中的半规管及面神经乳突段均完整保留。三维重建影像与尸头标本上测得的各关键点间线段在矢状面的投影距离之间的差异均无统计学意义(均P>0.05)。轮廓化半规管前的乙状窦前显露面积为(151.63±32.77)mm^(2),颞下显露面积为(113.12±53.10)mm^(2),手术自由度为(3017.04±839.77)mm^(2);轮廓化半规管后的乙状窦前显露面积为(200.85±42.93)mm^(2),颞下显露面积为(127.14±53.66)mm^(2),手术自由度为(4392.56±906.60)mm^(2),轮廓化半规管前、后上述指标的差异均有统计学意义(均P=0.005)。结论该研究中定义的最小乳突切除区域可以在不轮廓化半规管和面神经管的前提下保护半规管及面神经乳突段,但在一定程度上会减少乙状窦前和颞下的显露面积,以及降低手术自由度。ObjectiveTo explore the minimum mastoid osteotomy range required for the transpetrosal-presigmoid approach without contouring the semicircular canal and facial neural tube,and to study the effect of contouring on the surgical exposure area and surgical freedom.MethodsAdult patients without craniosynostosis who underwent cranial CT angiography(CTA)examination were enrolled,and the cranial CTA data were imported into 3D Slicer software for three-dimensional reconstruction.The 3D Slicer software was used to label the Henle′s spine,the apex of the superior semicircular canal,the midpoint of the lateral semicircular canal,the anterior point of the posterior semicircular canal,the posterior point of the posterior semicircular canal,and the tip of the mastoid process in the three-dimensional reconstruction of the bony model of the 100 cases.The projected distances in the sagittal plane were measured between the line connecting the Henle′s spine with the tip of the mastoid process and the key points of the semicircular canal,and the minimum bony protection area of the semicircular canal and the facial nerve was determined.Five cadaveric head specimens(10 sides)were collected to simulate a conventional transpetrosal-presigmoid approach and mastoidectomy,and the projected distances in the sagittal plane of the line segments between key points,the anterior sigmoid sinus-exposed area and the inferotemporal-exposed area,and the degrees of surgical freedom were measured before and after contouring the semicircular canals(i.e.,with and without removal of the protected areas).ResultsThe semicircular canals and the mastoid segments of the facial nerve were intact in all cadaveric head surgeries.There were no statistically significant differences between the measured projected distances on the sagittal plane from the three-dimensional reconstructions and the cadaveric specimens(all P>0.05).The area of anterior sigmoid sinus exposure before and after contouring semicircular canal was 151.63±32.77 mm^(2) and 200.85±42.93 mm^(2

关 键 词：模型 解剖学 体层摄影术 X线计算机 半规管 面神经 经岩乙状窦前入路 最小乳突切除 

分 类 号：R73[医药卫生—肿瘤]