颅中窝底硬膜外入路技术改进及相关解剖学  

Technique Modification and Relative Anatomy Study of the Extradural Middle Fossa Approach

作　　者：吴喜跃[1] 何理盛[1] 康德智[1] 陈陆馗[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005

出　　处：《福建医科大学学报》2003年第1期38-40,T003,共4页Journal of Fujian Medical University

摘　　要：目的　从应用解剖学入手 ,量化和微创化研究颅中窝底硬膜外入路及技术改进。　方法　对 10具 (2 0侧 )成人头颅标本进行颞骨岩部前表面显微结构的横断面观察 ,测量相关数据 ;对 3具 (6侧 )头颅标本模拟颅中窝底硬膜外入路 ,进行入路全程解剖观察 ,在微创化基础上探求扩大手术显露范围的方法及临床应用。　结果　 (1)形成带血管蒂颞肌 -筋膜瓣 ,供重建颅底用 ,减少术后脑脊液漏。(2 )确定棘孔、半月节压迹、弓状隆起 (AE)为入路重要路标 ,测量 AE与岩嵴的交点 -半月节压迹的距离为 2 2 .15± 1.4 8mm,外展神经 -半月节压迹 4 .5 0± 0 .36 mm。(3)磨除卵圆孔前外缘骨质 ,切开下颌神经鞘膜和半月节硬膜间腔 ,使中颅底内侧硬膜充分脱离前岩骨 ,扩大手术暴露。 (4 )结扎岩上窦内侧 ,硬膜切口呈双“T”形 ,扩大岩尖区及桥小脑角硬膜内结构的显露范围。　结论　确定颅中窝底硬膜外入路的重要路标 ,明确安全切除颞骨岩部前部及岩尖区骨质的范围 。Objective\ To provide detailed anatomical information for the extradural middle fossa approach(EMFA) with a proper technique modification.\ Methods\ The axial sections of anterior petrous bone structure were microscopically measured in 20 sides of 10 formalin fixed adult cadaveric heads.\ The EMFA was simulated and observed microscopically with a proper reformation in 6 sides of 3 heads and clinically applied.\ Results\ (1)The temporal muscle\|fascia flap with a vessel base attached is formed to reconstruct the cranial base.\ (2)The key landmarks are identified as a guide of safe operation.\ (3)The removal of the anterolateral bone of oval foramen and the opening of both the sheath of the mandibular nerve and the dural interspace of Gasserian ganglion help the medial portion of middle fossa dural nearly isolated with the anterior petrous bone.\ (4) The medial half of SPS was ligated.\ The double 'T' type of dural incision was formed to improve the exposure of PA and CPA.\ Conclusion\ The key landmarks in EMFA were defined.\ The limitation of anterior petrous apex region bone for safe resection was confined.\;

关 键 词：后颅窝 局部解剖学 显微外科手术 颞骨岩部 

分 类 号：R651[医药卫生—外科学]